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COMBINED REGISTRATION APPLICATION FORM

This Combined Registration Application (CRA) must be completed by all persons or companies conducting any business activity in Delaware,

or having one or more employees who will work in Delaware or who are residents of Delaware, for whom you are withholding Delaware

income tax.

The CRA additionally contains a Special Requirements for Contractors form, which must be completed by Resident Contractors and Non-

Resident Contractors (along with all listed additional forms).

PLEASE BE ADVISED: If you are applying for a license categorized under ‘Private Detective,’ ‘Security Guard Co,’ ‘Security

Systems,’ ‘Bail Enforcement Agent,’ or ‘Pawnbroker/Secondhand Dealer/Scrap Metal Dealer,’ you MUST FIRST obtain State Police

approval in order to obtain a validated State business license.

Withholding and Gross Receipts returns can be filed electronically online at If you wish to file a paper gross

receipts return, you must log into the gross receipts website and print personalized gross receipts forms. If you wish to file paper withholding

returns, you will find blank returns under the forms link on our website. Please direct any questions or concerns regarding this application to

(302) 577-8778 or (302) 577-8779.

Upon completion of this form, you may mail the CRA, with the required license fee(s), if

applicable, to:

DIVISION OF REVENUE

P.O. BOX 8750

WILMINGTON, DE 19899-8750

NOTE: This application may not be accepted if all the necessary information is not provided, or if the application is not signed and

dated by an owner or officer.

SPECIFIC LINE INSTRUCTIONS - PLEASE READ CAREFULLY - PLEASE PRINT CLEARLY OR TYPE

Line 1 (FEIN or SSN). Enter your Federal Identification Number (FEIN) or Social Security Number (SSN), whichever you use for federal

purposes. If you are an employer or business ownership that is not a Sole Proprietorship, you must have a FEIN. You can apply for a number

using Federal Form SS-4, or by calling your nearest IRS office. If you have applied for a FEIN, please enter “Applied For” on Line 1, and the

Division of Revenue will assign a temporary number until your FEIN has been received. You must notify the Business Master File Unit at

(302) 577-8778 when your FEIN is obtained. All of your tax returns should be filed under ONE ID number. If you are a sole proprietor and

you have obtained a FEIN, you must enter both numbers on Line 1 of Part A or C.

Part A - To Be Completed By All Taxpayers That Need To Register Their Business Or Withholding For The First Time

All applicable questions in Part A MUST be answered.

Line 1

Name

Enter the name of the business (individual, partnership, corporate name, governmental agency, etc.).

Line 2

Trade Name

Enter the trade name of your business if different from the primary business name on Line 1.

Line 3

Primary Location

Enter the address of your primary business location; this is the physical address where the license

Address

will be displayed (a P.O. box is not an acceptable primary location address).

Line 4

Mailing Address

Enter the address to which correspondence should be mailed, if different from your primary business

location.

Line 5

Accounting Period

Please check the appropriate box that indicates the period of your taxable year. If you are a fiscal

year taxpayer, please enter the last month and day of the taxable year.

Line 6

Incorporation State

If you are incorporated, please enter the two letter postal abbreviation for state in which you are

incorporated.

Line 7

Incorporation Date

If you are incorporated, please enter the date on which you became incorporated.

Line 8

Start Date

Enter the date your business operations began, or will begin in Delaware

Line 9

Ownership Type

Enter one of the following applicable two digit ownership codes:

01 Sole Proprietorship

09 Cooperative

23 Limited Liability Company

31 LLC - Corporation

02 Partnership

10 Other (Explain)

24 Limited Liability Partnership

32 LLC - Non-Elect

03 Non-Profit Corporation

11 Holding/Investment Company

25 Delaware State Government

33 LLC - Non-Elect Individual

04 Corporation

12 Professional Association

26 Delaware County Government

34 QSSS

06 Sub-Chapter S Corporation

18 Employer - Domestic Employee(s)

27 Delaware Municipal Government

35 Withholding Agent Only

07 Federal Government

20 Bank

28 Other State Government Agency

08 Fiduciary (Estate or Trust)

21 Insurance Company

30 LLC - Partnership

Line 10

Sub Chapter S

If you indicated ‘06 - Sub Chapter S Corporation’ on Line 9, indicate if you have shareholders that are

Corporations

NOT Delaware residents.

Line 11

Parent Company Name

If you have a parent company, enter the name.

Form Cra - Combined Registration Application For State Of Delaware Business License And/or Withholding Agent Page 2

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