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              Regional Income Tax Agency
FORM          Business Registration Form 
48
                                                                      Access ritaohio.com to register electronically using MyAccount. Login to 
                                                                      MyAccount to Add a Municipality or Add Subcontractor. These features allow 
              Municipality
                                                                      you to report a new location or new subcontractor project electronically.  
Business Type                                                         Reason for Registration
Corporation                     Non-Profit                            Courtesy withholding for an employee's resident municipality
S-Corp                          Estate & Trust                        Doing business within the municipality this year (temporary)
LLC                             Sole Proprietor / LLC                 Approx. # of days                     Start Date
                                                                      Business with a fixed location
Partnership                                                           Date business began at this location

 Company Information            (List physical address of work performed within this municipality)

Name:                                                                 Federal ID #:

Address:                                                              SSN :
                                                                                                  (required if sole proprietor)
City/State/Zip:

Mailing Address (for withholding tax forms / if different from above) Mailing Address         (for net profit tax forms / if different from above)

*Please note that your Federal Identification Number will serve as your RITA account number.
Filing Status:
       Calendar year                Fiscal year / month ending
Do you have any employees?          Yes                No
Number of employees at RITA location
My withholding is filed under a 3rd party account (PEO or common paymaster)                   Yes    No
  If yes, list Federal ID #        
Monthly gross payroll at RITA location  $
I am a small employer (under $500,000 in gross revenue during previous year)                  Yes    No
Contractors
I am a contractor  Yes           No
Will you be using sub-contractors?              Yes       No
If yes, complete page 2.
Total contract amount of the project  $

The Information Hereby Submitted is True and Correct.

Print Name                                                            Title                               Phone Number
                                                                                                                      /        /
Signature                                                                                                 Date
Please complete and sign this Registration Form and return within 10 business days. Please be advised that failure to timely register with RITA may result in delays in the 
processing of any required income tax filings or may result in future penalty and interest charges, if applicable. If you have any questions please contact the Registration 
Department at the number below. 
Mail to:RITA                                                                                        Call: 800.860.7482, ext. 5008
ATTN: BUSINESS REGISTRATION                                           ritaohio.com                        TDD: 440.526.5332      
P.O. BOX 477900                                                                                     Fax:  440.922.3536
BROADVIEW HEIGHTS, OH 44147-7900

  Sub-contractor Name / Address                                                $
                                 Contact Name                                  Contract Amount

                                 Phone Number                                  Estimated Start Date

                                 EIN or Social Security #                      Trade

  Sub-contractor Name / Address                                                $
                                 Contact Name                                  Contract Amount

                                 Phone Number                                  Estimated Start Date

                                 EIN or Social Security #                      Trade

  Sub-contractor Name / Address                                                $
                                 Contact Name                                  Contract Amount

                                 Phone Number                                  Estimated Start Date

                                 EIN or Social Security #                      Trade

  Sub-contractor Name / Address                                                $
                                 Contact Name                                  Contract Amount

                                 Phone Number                                  Estimated Start Date

                                 EIN or Social Security #                      Trade

  Sub-contractor Name / Address                                                $
                                 Contact Name                                  Contract Amount

                                 Phone Number                                  Estimated Start Date

                                 EIN or Social Security #                      Trade

  Sub-contractor Name / Address                                                $
                                 Contact Name                                  Contract Amount

                                 Phone Number                                  Estimated Start Date

                                 EIN or Social Security #                      Trade

*If more space is needed, you may attach a separate schedule that includes ALL  of the required information listed above.

 Mail to:RITA                                                                   Call: 800.860.7482, ext. 5008
 ATTN: BUSINESS REGISTRATION                  ritaohio.com                            TDD: 440.526.5332                   
 P.O. BOX 477900                                                                Fax: 440.922.3536
 BROADVIEW HEIGHTS, OH 44147-7900