SCHEDULE 
                               REGISTRATION OF ADDITIONAL 
            DBA
            WV BUS-APP                          TRADE NAMES 
Attach multiple copies of this form if needed. Trade names and DBAs not submitted on the BUS-APP, BUS-RBL, or this form, may not be properly added 
to account. 
                               SECTION A: REASON FOR SUBMITTING THIS APPLICATION 
 CHOOSE ONLY ONE:      SUBMITTED WITH SUBMITTED WITH SENT      TOTAL NUMBER OF DBAs OR TRADE NAMES:
                       BUS-APP        BUS-RBL        SEPARATELY
                                      SECTION B: PRIMARY BUSINESS IDENTIFICATION 
   LEGAL BUSINESS NAME                                         FEIN (SSN For Sole Proprietor) 
 1

   CONTACT                                                     TITLE

 2
   CONTACT EMAIL                                               PHONE NUMBER

                                      SECTION C: ADDITIONAL DBA OR TRADE NAMES
   TRADE NAME                                                  WV TAX ACCOUNT # (If associated with a specifi c WV tax account)

   ADDRESS If this trade name is to be used at a specifc location, diff erent than the Primary business, list here. If it applies to all locations of the business, write SAME. No PO Boxes
 3

   CITY                                                        STATE                          ZIP

   TRADE NAME                                                  WV TAX ACCOUNT # (If associated with a specifi c WV tax account)

   ADDRESS If this trade name is to be used at a specifc location, diff erent than the Primary business, list here. If it applies to all locations of the business, write SAME. No PO Boxes
 4

   CITY                                                        STATE                          ZIP

   TRADE NAME                                                  WV TAX ACCOUNT # (If associated with a specifi c WV tax account)

   ADDRESS If this trade name is to be used at a specifc location, diff erent than the Primary business, list here. If it applies to all locations of the business, write SAME. No PO Boxes
 5

   CITY                                                        STATE                          ZIP

   TRADE NAME                                                  WV TAX ACCOUNT # (If associated with a specifi c WV tax account)

   ADDRESS If this trade name is to be used at a specifc location, diff erent than the Primary business, list here. If it applies to all locations of the business, write SAME. No PO Boxes
 6

   CITY                                                        STATE                          ZIP

   MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT 
            TAX ACCOUNT ADMINISTRATION DIVISION 
            REGISTRATION & ACCOUNT CORRECTION UNIT
            PO BOX 2666
            CHARLESTON WV 25330-2666
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