Local Hospitality Tax Registration Form

Date Opened:*

D/B/A Business Name*

State Retail License Number*

Federal ID or SSN*

Physical Location*

City*

State*

Zip*

Business Phone*

Estimated Monthly Sales Subject to Hospitality Tax*

Owner, Partnership, or Corporate Charter Name*
Address*
City*
State*
Zip*
Contact Name*
Contact Phone*

Name*

Address*

City*

State*

Zip*

Email Address*

Name of Party Responsible for Reporting Hospitality Tax*

Contact Name*

Contact Phone*

Email Address*

Please enter name, ID/DL #, and state where issued of all authorized to sign checks for hospitality tax payments 1.
2.
3.
4.

Submit