EMAIL: RA-BTFTREGISFAX@PA.GOV                                                                                                                      FAX :717-787-3708                                                                                  DAYTIME TELEPHONE            EXT.      SIGNATURE/TITLE FAX OR EMAIL TO:   NAME                                                                                         SSN                                                                                                                                                                                            SECTION V.                                              ADDRESS                                                                                             MAILING                                               (NO PO BOX)                              ADDRESS                                         LOCATION                                                       ADDRESS               PRIMARY                                      NAME TRADE                            NAME                              LEGAL                                                                          SECTION II.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                EXISTING TAX ACCOUNT ID                             ENTITY ID (EIN/SSN)                             CORRECT ENTITY ID (EIN/SSN)                                                                                                                                                                       SECTION I.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      INdIVIduAl owNER(S), PARTNER(S) oR CoRPoRATE offICER(S) RESPoNSIblE foR RETuRN INfoRmATIoN. ownership change requires a new registration (PA-100).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             ExISTINg lEgAl NAmE/TRAdE NAmE/AddRESS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             If your EIN was changed by the IRS, you must complete a new registration form (PA-100).  SAlES/uSE TAx, PTA, VRT ANd CIgARETTE dEAlER’S lICENSES ARE NoN-TRANSfERAblE.

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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 ADDRESS                                                                                             MAILING                                               (NO PO BOX)                              ADDRESS                                         LOCATION                                                       ADDRESS               PRIMARY                                      NAME TRADE                            NAME                              LEGAL                                  NEw lEgAl NAmE/TRAdE NAmE/AddRESS

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                                                                                                                                                                                PLEASE SIGN AFTER PRINTING                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      TYPE OF TAX:      ACCOUNT ID NUMBER                              SECTION IV.                                                         COUNTY:                                                   SECTION III.                                         EMPLOYER                                                                 SALES:             
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NEXT PAGE                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           CIGARETTE                                      VRT                                                PTA TAX                                                                  EMPLOYER TAX                            SALES/USE TAX                                                                                                             PHILADELPHIA      ALLEGHENY                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   MORE FREQUENT FILING STATUS ONLY)
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               oThER TAx ChANgES                                                                                                           Add loCAl SAlES TAx                                     SEMIWEEKLY             SEMIMONTHLY                                                                           MONTHLY
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             section. Enter the date(s) of the first sale from either one or both counties, if applicable. it does not currently report the local sales tax for that/these county(ies), complete this If a business opens a new location in Allegheny and/or Philadelphia county(ies), and                                              sEctIon III.                      section.                                                    be completed. If the                                           (e.g., incorporation or a change in ownership), a new registration form (PA-100) must However, if your legal and/or trade name changed as a result of a business reorganization Complete this section if your legal and/or trade name changed or if correcting an error. sEctIon II.               be effective only at the beginning of a filing period.                                                                            appropriate block for sales tax or employer withholding. if you have received a new EIN. To change to a more frequent filing status, check the by the Internal Revenue Service. A new registration form (PA-100) must be completed Enter your eight-digit Account ID Number. Update your federal EIN if it has been changed sEctIon I.                                                                                                                                      www.etides.state.pa.us using the Enterprise maintenance function.                   non-transferable.                                           other business taxes. Sales/use tax, PTA, VRT and cigarette dealer’s licenses are                                     and remit local sales tax.                                  corrections, a change to a more frequent filing status and/or to register to collect                                                                                      This form is to be used to report Entity ID (federal EIN/SSN), business name, address

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                                                                                                                                                                                                                                                                                                                                                                          a post office Box is not acceptable for a physical location.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          E-tIDEs users may make changes directly to their accounts at
                                                                                                                                                                                                                                                                                                                                                                                                                                      Primary, Location and/or Mailing Address changed, complete this
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          change in filing status will

             with Special Hearing and/or Speaking Needs 1-800-447-3020 (TT only).                          call the department’s Forms Ordering Service at 1-800-362-2050.                                                                                                                 To obtain a PA Enterprise Registration Form,              REgIstRatIon mEthoDs                                                             Email: RA-BTFTREGISFAX@PA.GOV                                  Fax: 717-787-3708                                                                     Include a daytime telephone number and title. Fax or Email                                sIgn anD DatE thE foRm                                                                               ID number(s).                                                        a new registration form (pa-100) must be completed to obtain a new account                                                          the restructure of a business (e.g., incorporation or a change in ownership),         If the owner(s), partner(s), or corporate officer(s) changed as a result of                                                                                                  for return information, complete this section. If there are changes to the individual owner(s), partner(s), or corporate officer(s) responsible                                                                   sEctIon V.                                                                                                                                                      corresponding Account ID Number(s).                                                             If changing information for other taxes, check the appropiate box and enter the            sEctIon IV.

                                                                                                                                                                                                                                                                                           PA-100, visit 
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                                                                                                                                                                                                                                                                                           www.pa100.state.pa.us                                                                                                                                                                                                                                                                           the completed form to: 

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