City of Englewood Income Tax Department                                 BUSINESS QUESTIONNAIRE 
333 W National Rd, Englewood OH  45322 
Phone (937) 836-5106 Fax (937) 771-2891                                               ENGLEWOOD TAX RATE 1.75%
Email:  tax@englewood.oh.us 
Website:  www.englewood.oh.us 

The following information is required to properly establish your City of Englewood income tax account.  Please answer 
questions fully and return this questionnaire to the address shown above.  All information will remain strictly 
confidential. 

GENERAL INFORMATION 

Business Name: _____________________________________________   Federal ID or SSN of Owner: _______________ 

Type of Business: _____________________________________________________________________ 

Mailing Address: _________________________________________________________________  

Englewood Address (if different): ________________________________________ Phone: _____________________ 

Date Business began in Englewood: _____/_____/_____ 

Type of Business Ownership:   Sole Proprietor ___  Corporation___  S-Corp ___     Partnership ___LLC ___   Other _____ 

EMPLOYEE WITHHOLDING INFORMATION 

Date Employees began working in Englewood: _____/_____/_____ Number of Employees in Englewood ______ 

Are you a Monthly or Quarterly withholder?  M______ Q ______, Note: If your withholding remittance is more than 
$600 per quarter, you must remit on a monthly basis. 

Are you a non-resident business withholding for a resident employee only? ___________(Courtesy Withholding) 

       Date Courtesy Withholding began: _____/_____/_____ Number of Employees withholding for:__________ 

       Address where work is actually performed: _______________________________________________ 

ACCOUNTING INFORMATION 

Accounting Period:  Calendar Year_______ or Fiscal Year Ending _____/_____/_____ 

Contact Person: __________________________________________ Phone: ____________________ 

Address (if different): ________________________________________________________________ 

Email: ____________________________________ May we use this email to contact you? Yes ____ No_____ 

CONTRACTOR AND SUBCONTRACTOR INFORMATION 

Do you use Subcontractors?  No ______ Yes ______.  If you are using Subcontractors, for any portion of your business, 

please attach a list of the NAME, ADDRESS and FEDERAL ID number(s) or SOCIAL SECURITY NUMBER(s) of the 

COMPANY(IES) or INDIVIDUAL(S) who contract with you.  

Print Name: ___________________________ Signature: ______________________________ Title: _________________ 

Phone Number: ____________________ Email: ____________________________________Date_____/_____/_____