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Line 12 Parent Employer ID Enter employer ID number or social security number of parent company, and check the applicable
box.
Line 13 Previous Business If you changed the name of your business, enter your previous business name.
Name
Line 14 Previous ID Number Enter the ID number of your business if it has changed, and check the applicable box.
Line 15 Contact Enter the name, phone number, fax number, and e-mail address of the individual who should be
contacted regarding tax matters.
Line 16 Ownership Enter the name(s), title(s), and SSN(s) of the proprietor, partner, or principal officers of your business.
If there are more than three, please attach a separate list. If you have a Registered Agent, provide
that information as well.
Line 17 Business Activity Fully describe the specific nature of your business.
Part B - To Be Completed by All Taxpayers
Line 1 Employment and Answer whether you will have employees in DE or if you will withhold DE state tax from DE residents
Withholding who work out of state.
Part C - To Be Completed By All Taxpayers Applying for a License
Delaware law requires every person, firm, or corporation conducting a business within this state to obtain a license and to pay an additional
monthly or quarterly fee based on the aggregate gross receipts derived from the operation of such a business. Failure to obtain a business
license will result in a $200 penalty if such failure is not self-disclosed. A separate business license is required for each separate
business activity, and may be required for multiple locations of certain business (Please consult the Division of Revenue License
and Tax Rates chart for more info). If you need to apply for more than one license, you will need to obtain, and complete, a supplemental
License Application and submit one with the appropriate payment for each license you require. The license fee must accompany any
license application. Applications without the license fee will not be processed.
Line 1 Name Enter the name of the business (individual, partnership, corporate name, governmental agency, etc.).
Line 2 Trade Name Enter the name trade name of your business if different from the primary business name on Line 1.
Line 3 Physical License Enter the address of your primary business location (A P.O. box is NOT an acceptable physical
Location Address location address).
Line 4 Mailing Address Enter the address to which correspondence should be mailed, if different from your physical license
location.
Line 5 Start Date Enter the date your business operations began, or will begin in Delaware.
Line 6 License Year Enter the year for which you are applying for a license. (If you are applying for an additional location
of an activity where the primary license is on a 3 year cycle, enter the year that the 3 year cycle ends,
and prorate the additional location fee accordingly. See Additional Business License form.)
Line 7 License Activity Fully described the specific nature of your business and provide the business code (see previous
Description page).
Line 8 65 Years or Older Check box if applicable. Any person who is 65 years of age or older whose gross receipts are less
than $10,000 per year shall pay 25% of the annual occupational license fee specified.
Line 9 Total Fee Enter the total license fee. See below for more details on this computation.
Below is a sample schedule for computation of fee for any license for which you may apply. To calculate your license fee, you will need to
locate your business category on the ‘Detailed List of Division of Revenue Licenses and Tax Rates’ chart and find the annual fee
due. If you are applying for a license for an additional location, you will need to locate the additional location fee for your business
category and from that calculate the fee due.
If you start doing business in Delaware after January 31, you may prorate the fees for your initial year according to this schedule, unless
you are registering under business categories: Cigarette, Motor Vehicle Dealer, Circus Exhibitors, or Outdoor Musical Festival
Promoters.
Decals for Cigarette Vending Machines, Merchandise Vending Machines, and Amusement Machines are proratable upon first application, or
as additional machines are purchased and placed in services.
(Proration Example: If you start doing business in Delaware in the month of April, and you are a retailer: $75.00 x 0.75 = $56.25 Total Fee). If
your license fee is based on a number of units (like the number of rooms for a motel), then multiply the annual fee by that number first.
Proration Basis for Initial Licenses Jan - 100% Apr - 75% July - 50% Oct - 25%
Multiply Annual Fee by Respective Feb - 92% May - 67% Aug - 42% Nov - 17%
Month Mar - 83% Jun - 58% Sep - 33% Dec - 8%
COMPUTATION OF FEE $ x % = $
Annual Fee Prorated Percentage Total Fee
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