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Regional Income Tax Agency 
Business Change of Address Form 

Account Type 

      Withholder                                        Complete each section below to update your business 
                                                        mailing address. A current address will ensure that you 
      Net Profit 
                                                        receive important mailings pertaining to your business 
      Both Withholder and Net Profit                    account(s). 

Company Information:
Business                                                Federal 
Name:                                                   ID#: 

                                                        SSN: 
                                                                    (required if sole proprietor) 

New Mailing Address         (for Withholding tax forms) New Mailing Address (for Net Profit tax forms)               
                                                                     Complete if different from Withholding address 

Address:                                                Address: 

City:                                                   City: 

State:                                                  State: 

Zip:                                                    Zip: 

                           *Please note that your Federal Identification Number is your RITA account number. 

The Information Hereby Submitted is True and Correct: 

___________________________________________________     ______________________         ________________________ 
Print Name                                              Title                          Phone Number 

_______________________________________________________________________________        ________________________ 
Signature                                                                              Date (mm/dd/yyyy)

                            Please complete and sign this Form and either Mail or Fax. 
           If you have any questions, please contact the Business Compliance Department at the number below. 

Mail to: RITA                                                                    Call: 800.860.7482, ext. 5003 
           ATTN: BUSINESS REGISTRATION                                                  TDD: 440.526.5332 
           P.O. BOX 477900                             ritaohio.com 
           BROADVIEW HEIGHTS, OH 44147-7900                                      Fax:  440.922.3536