Date______________________ 

                                          City of Westerville 

                                  Business Registration                                            
 
The information requested on this form is essential to the establishment of your account and will be held in strict confidence.  Please complete, sign 
and return to the City of Westerville Income Tax Division, PO Box 130, Westerville, OH 43086-0130 within 10 days.  If you have any questions, 
please contact the Income Tax Division @ (614) 901-6420 or by email at incometax@westerville.org. 
 
Type of Organization  
 
  Corporation            Partnership            Non-Profit       Trust          Other (please explain) _____________________ 
 
  LLC- Partnership     LLC- Corporate      LLC- Single Member- List Name and SSN __________________________  
 
Business Information 
 
Federal ID # _________________________________ Type of Business _______________________________________ 
 
Business Name _______________________________ dba __________________________________________________ 
 
Address _____________________________________ City ____________________ State __________Zip ___________ 
 
Telephone # __________________________________ Fax # ______________________________________ 
 
List Social Security Number and Name(s) of Corporate Officer(s) or owner(s): 
 
Name _________________________________________   SSN ______________________________________________ 
 
Address _______________________________________   City _________________State ________ Zip _____________  
 
Name _________________________________________   SSN ______________________________________________ 
 
Address _______________________________________   City _________________State ________ Zip _____________  
 
__________________________________________________________________________________________________ 
 
Are you conducting activity or do you have a business location within the city limits of Westerville?       Yes           No 
 
If yes, please give the Westerville address of activity or business location. If not sure, call (614) 901-6420 to verify. 
 
Address _______________________________ City __________________ State _____________ Zip _______________ 
 
Date operations will begin in Westerville? __________________ 
 
Number of employees at Westerville location? _________ 
                                                                                                       
                                                                                                      (Over) (Rev 01/22) 
                      P.O. Box 130 ⁕ Westerville, Ohio 43086-0130 ⁕ 614.901.6420 ⁕ Fax 614.901.6820 
                              Council-Manager Government Since 1916 
                                                               http://www.westerville.org 

Do you currently plan to use the Ohio Business Gateway to remit payments?           Yes                  No    
                                                                                                             
Do you wish for your forms to be sent to another location?              Yes             No 
If yes, please provide address: 
 
Address _______________________________ City __________________ State _____________ Zip _______________ 
 
Please check the appropriate box: 
 
     Employee(s) work(s) within city limits of Westerville – Withholding rate is 2.0%.    
 
     Employee(s) live(s)* in City of Westerville and work(s) in a non-taxing city-Withholding rate is 2.0 %.  
 
     Employee(s) live(s)* in City of Westerville and work(s) in another taxing city and you are going to courtesy withhold 
– full credit of actual tax withheld, limited to 2.0%.  
 
      Employee(s) live(s)* in City of Westerville and work(s) remotely from home -Withholding rate is 2.0%.  
        
        *Employee(s) home address____________________________________________________________________ 
 
      No employees. 
 
__________________________________________________________________________________________________ 
 
SELECT TYPE OF PAYROLL     In-house     Payroll Service    PEO     Employee Leasing Company 
 
NAME OF PAYROLL SERVICE, PEO, OR EMPLOYEE LEASING COMPANY___________________________ 
 
Please indicate deposit frequency. If a withholding service is being used advise them to withhold. 
                                    
   Quarterly (under $200.00/month    Monthly (over $200.00/month    Semi Monthly (over $1,000.00/month) 
 
Please note: Westerville is not a pure zip code for taxing purposes.  If you have any questions regarding what tax district 
you are in, please call and we will verify this information.  Forms are now available on our website at 
www.westerville.org .  
 
No confirmation will be sent regarding the assignment of an account number.  We use your federal ID#. 
 
__________________________________________________________________________________________________ 
 
Person to contact regarding this account _________________________________________________________________ 
 
Phone # ________________________________ Email _____________________________________________________ 
 
Signature ________________________________________________Date ______________________