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WV BUS-APP WEST VIRGINIA NEW BUSINESS
Rev 01-21 REGISTRATION APPLICATION
Register online at business4.wv.gov. Remote sellers are encouraged to use the simpli edﬁ registration process online at mytaxes.wvtax.gov.
If you are making changes to a business already registered with the WV State Tax Department, do not use this form. Go to mytaxes.wvtax.gov or submit BUS-RBL.
Delays issuing your business license may occur if you fail to submit ALL the pages of this form, fail to complete all required sections, or do not include all required
supporting documentation. Handwritten forms may take longer to process.
PART 1
SECTION A: REASON FOR SUBMITTING THIS APPLICATION Choose only one.
NEW BUSINESS EXISTING BUSINESS OPENING NEW LOCATION WITHHOLDING ONLY (skip page 2)
You do not currently have a business license You have a business license issued by the WV State Tax You only have employees in WV and
issued by the WV State Tax Department for any of Department for at least one location but are opening an will not engage in purposeful revenue
your business activity at any location. additional business location. generating activity in this state.
SECTION B: BUSINESS IDENTIFICATION
Sole Proprietors must complete FIRST and LAST NAME and SSN on Line 1A and skip line 1B. All others must skip line 1A and enter LEGAL NAME OF BUSINESS and the BUSINESS FEIN on line 1B.
1A. LEGAL NAME OF SOLE PROPRIETOR FIRST NAME MIDDLE INITIAL LAST NAME SUFFIX SSN OF SOLE PROPRIETOR

1B. LEGAL NAME OF ENTITY FEIN

2. DBA (Complete Schedule DBA for additional DBAs and trade names)

3. STREET
ADDRESS LINE 1
STREET UNIT UNIT
ADDRESS LINE 2 TYPE NUMBER
(OPTIONAL)
CITY STATE ZIP

COUNTRY FOR LOCATION ADDRESS COUNTY
IF IN WV, IS THE BUSINESS WITHIN CITY LIMITS NO YES

4. MAILING
ADDRESS LINE 1
MAILING UNIT UNIT
ADDRESS LINE 2 TYPE NUMBER
(OPTIONAL)
CITY STATE ZIP

COUNTRY FOR MAILING ADDRESS 5A. EMAIL ADDRESS 5B WEBSITE

6. WILL YOU HAVE 6A. DATE YOU WILL BEGIN 6B. NUMBER OF 6C. TO CONSOLIDATE YOUR Consolidated Withholding
WEST VIRGINIA WITHHOLDING WV EMPLOYEES WITHHOLDING TAXES UNDER
EMPLOYEES? NO YES INCOME SUBJECT TO WV AN EXISTING WITHHOLDING
If yes, answer 6A (MMDDYYYY) INCOME TAX ACCOUNT, ENTER THE EIGHT
and 6B DIGIT ACCOUNT NUMBER
7. DATE BEGINNING 8. TAXABLE YEAR END 9. ESTIMATED ANNUAL GROSS INCOME 10.BUSINESS PHONE
area code phone number
BUSINESS IN WV FOR FEDERAL TAX
(MMDDYYYY) PURPOSES
(MM) .
SECTION C: BUSINESS ACTIVITY
11. DESCRIPTION OF BUSINESS ACTIVITY In detail, explain what your business will do or is doing in WV.

12. NAICS CODES (6 digits preferred) PRIMARY NAICS SECONDARY NAICS ADDITIONAL NAICS
Provide the North American Industry Classi ﬁcation
System Codes that represents your business
activity. For help, See page Worksheet 1 in the
Instructions.

*B29202101W*
B29202101W
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WV BUS-APP PART 1 continued 
Delays issuing your business license may occur if you fail to submit ALL the pages of this form, fail to complete all required sections, or do not include all required supporting documentation. 
                                                       SECTION C : BUSINESS ACTIVITY CONTINUED
13. GENERAL ACTIVITY - Select all that apply. Must select at least one. Certain activities require additional documentation as noted. If you only have 
employees in WV and will not engage in purposeful revenue generating activity in West Virginia, leave this page blank. See Instructions for more information. 

SALES AND SERVICES - Sell tangible personal property, provide services or conduct maintenance work from a WV location or to Customers in WV. 
IF YOU WILL BE CONSOLIDATED FILING  SALES AND SERVICE TAX UNDER AN EXISTING SALES 
TAX ACCOUNT, PLEASE ENTER THE EIGHT DIGIT WV SALES TAX ACCOUNT NUMBER HERE: 
Which of the following goods, services, or maintenance work do you provide? 

BEER- Will you hold a license to sell beer to           WINE- you will sell wine to licensed wine        CONSTRUCTION- make alterations, repairs, improvements, and decorations 
licensed beer distributors or retailers                 distributors or retailers or WV registered       to real property and structures that constitute capital improvements. For further 
                                                        wine suppliers                                   information on what constitutes a capital improvement,consult TSD-310.
WINE/LIQUOR -  As a retailer, will you hold a           You will sell alcohol as a private club, bar,    NON-RESIDENT CONTRACTOR
license to sell liquor and/or wine by the bottle?       or restaurant                                    Must be properly bonded and  ﬁle an itemized listing of equipment and materials 
(Not sold in clubs, bars, or restaurants)                                                                brought into West Virginia for use in contracting activity.
MANUFACTURING                                                                                            COLLECTION AGENCY
                                                                                                         Attach CAB-1. Must be properly bonded
SOFT DRINK                      SOFT DRINK              SOFT DRINKS PRODUCTS CROWN                       TELEMARKETING to WV residents
PRODUCTS                        PRODUCTS                MANUFACTURER (bond required)                     Attach form TLM and Corporate Surety Bond. Must be properly bonded
BOTTLER                         WHOLESALER
SOFT DRINKS RETAILER purchases from a                   SOFT DRINKS RETAILER purchases from a            EMPLOYMENT AGENCY
bottler or wholesaler without excise tax paid           bottler or wholesaler with excise tax paid       Attach letter from the Commissioner of labor
FIREWORKS                                                                                                MAKE CONSUMER OR SUPERVISED LOANS
Must be licensed by the State Fire Marshal                                                               Attach BUS-CSL
DRUG PARAPHERNALIA                                                                                       PRENEED CEMETERY
Attach forms DRUG 1 and DRUG 2. Pay Additional Fee.                                                      Attach CEM-1 and CEM-B

TRANSIENT VENDOR-Sell tangible personal property to consumers at retail level and do not                 OPERATE NATURAL GAS STORAGE
maintain an established place of business in West Virginia
AttachTVL-1.$500 bond or certi ﬁ      ed check required.
RENTAL                                                                                                   PROVIDE ELECTRIC 
                                                                                                         POWER
SCRAP METAL DEALER OR RECYCLER                                                                           PUBLIC UTILITIES regulated by the PSC

SOLID WASTE                                                                                              OTHER SALES, SERVICE, OR MAINTENANCE NOT LISTED.  

TOBACCO PRODUCTS 
Mark all products you will sell (must select at least one):                           Mark which describes you (must select at least one) 
CIGARETTES                      OTHER TOBACCO           E-CIGARETTE LIQUIDS           MANUFACTURER           WHOLESALER                   RETAILER
                                PRODUCTS
NATURAL RESOURCES                   - hold title to or economic interest in severing, reducing to possession and producing for sale, pro ﬁt or commercial use, any natural 
resource product (unless only for royalties) A permit from Department of Environmental Protection also required
TIMBERING                       COAL - producer         COAL - processor              NATURAL GAS            LIMESTONE           SANDSTONE            OIL           OTHER 
Requires Division                                                                                                                                                   RESOURCES
of Forestry permit
FUEL - purchase, import, export, re ﬁne, or transport motor fuel  in WV meant for sale or pro ﬁ       t. 
Attach WV/MFT-APP
COMMON CARRIER - operate aircraft, watercraft or locomotives that transport freight or passengers within West Virginia. 

HEALTHCARE - provide health care services (only includes ambulances, practitioners, hospitals, nursing home care, and x-rays) 

MEDICAL CANNABIS - grow/produce or dispense medical cannabis                          GROWER                 PROCESSOR                    DISPENSARY
Requires license from O  ﬃce of Medical Cannabis
FARMING

USE COMMERCIAL WEIGHING OR MEASURING DEVICES
Must register with Division of Labor
OTHER/ACTIVITY NOT LISTED 

                                                                                                             *B29202102W*
                                                                                                              B29202102W
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      WV BUS-APP PART 1 continued 
      Delays issuing your business license may occur if you fail to submit ALL the pages of this form, fail to complete all required sections, or do not include all required supporting documentation. 

                                                                 SECTION D: BUSINESS OWNERSHIP
14. OWNERSHIP TYPE select at least one of the options below. 
                                                                     IF YOU ARE A CORPORATION,                                IF YOU ARE NOT A PARTNERSHIP OR A CORPORATION, 
    SOLE PROPRIETOR                                                    CHOOSE ONE BELOW:                                                                CHOOSE ONE BELOW:
                                                            DOMESTIC CORPORATION                                              LIMITED LIABILITY COMPANY
IF YOU ARE A  PARTNERSHIP, CHOOSE 
ONE BELOW:                                                  FOREIGN/OUT OF STATE                                                    SINGLE MEMBER LLC
                                                            CORPORATION
    GENERAL PARTNERSHIP                                                                                                             TREATED AS A S CORPORATION
                                                       If S Corporation, check the box and enter   rstﬁ      year to 
    LIMITED PARTNERSHIP                                which the S status applies (YYYY)                                            TREATED AS A C CORPORATION

If applicable, enter date when your partnership                                                                               JOINT VENTURE
elected not to be treated as a partnership 
under Internal Revenue Code Section 761 
(MMDDYYYY)                                           Will you  ﬁle your corporate income tax returns in WV on                 ASSOCIATION
                                                     a combined basis under a parent? If so, enter parent’s 
                                                     FEIN and Name.                                                           CHARITABLE ORGANIZATION
                                                                                                                              A copy of the IRS 501-C determination is required. Failure to submit a 
                                                            FEIN                                                              copy will result in this business not being granted the exemptions given 
                                                                                                                              to an organization performing charitable activity. 
                                                          NAME                                                                OTHER (specify):

                                                                     SECTION E: RESPONSIBLE PARTY
Complete a line for each responsible party who is an owner, partner, member, corporateﬃo   cer, or trustee.  There must be at least one individual who is a responsible party. Please list this person on line 15.  
In the case of a sole proprietorship, provide owner information in line 15. In the case of a partnership, provide information for each general partner. 
Attach an additional page if needed. 
Each person listed will be considered to have authority to speak for and act on the behalf of the business when dealing with the WV State Tax Department. To grant authority to act on behalf of the business 
to an individual who is NOT an owner, partner, member, corporateﬃo   cer, or trustee; complete the WV-2848 Authorization of Power of Attorney. See instructions for additional information.
    FIRST                                            LAST                                          TITLE                                                SSN 
    NAME                                             NAME
15
    EMAIL                                                                                          EFFECTIVE DATE                                       PHONE  NUMBER    
                                                                                                   MMDDYYYY                                             WITH AREA CODE 

    FIRST                                            LAST                                          TITLE                                                SSN 
    NAME                                             NAME
16
    EMAIL                                                                                          EFFECTIVE DATE                                       PHONE  NUMBER    
                                                                                                   MMDDYYYY                                             WITH AREA CODE 

    FIRST                                            LAST                                          TITLE                                                SSN 
    NAME                                             NAME
17
    EMAIL                                                                                          EFFECTIVE DATE                                       PHONE  NUMBER    
                                                                                                   MMDDYYYY                                             WITH AREA CODE 

    FIRST                                            LAST                                          TITLE                                                SSN 
    NAME                                             NAME
18
    EMAIL                                                                                          EFFECTIVE DATE                                       PHONE  NUMBER    
                                                                                                   MMDDYYYY                                             WITH AREA CODE 
                                                                             SECTION F : SIGNATURE
THIS REGISTRATION FORM MUST BE SIGNED BY A RESPONSIBLE PARTY WHO IS AUTHORIZED TO SIGN ON BEHALF OF THE ORGANIZATION.     
THE PROPRIETOR MUST SIGN FOR A SOLE PROPRIETORSHIP. 
 Under penalty of perjury, I declare that I have examined this application, accompanying documents, and statements, and to the best of my knowledge and belief, it is true, correct and complete.

Signature of O  ﬃcer/Partner or Member                           Print name of O  ﬃcer/Partner or Member                                Title                           Date
A $30.00 registration tax is due with this application with the exception of: charitable organizations, government agencies,                                            AMOUNT DUE
                                      agricultural/farming activities or a “withholding only” account.
   For this application to be valid and to avoid a delay in processing, all pages must be completed and application signed.
                 This application may be photocopied as proof of registration until your Certi ﬁcate(s) are issued.                                                     $     30.00

    MAIL TO:  WEST VIRGINIA STATE TAX DEPARTMENT 
                     TAX ACCOUNT ADMINISTRATION DIVISION 
                     REGISTRATION & ACCOUNT CORRECTION UNIT
                     PO BOX 2666
                     CHARLESTON WV 25330-2666                                                                                 *B29202103W*
                                                                                                                              B29202103W
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                                                PART 2 :UNEMPLOYMENT COMPENSATION
                                                SECTION E: UNEMPLOYMENT COMPENSATION
                 COMPLETE THIS SECTION TO REGISTER FOR AN UNEMPLOYMENT COMPENSATION ACCOUNT. 
                       All new businesses are required to complete this section, even if they have no employees in West Virginia
 1. Reason for applying:                                                            2. Name, street address, telephone number and person to contact where 
           New Business                                                                 payroll records are maintained:
                                                                                        Name
           Additional Location
                                                                                        Address
           Purchased Business
                                                                                        City                                                    State              Zip Code
           Out of State Business, registering for Withholding Only
                                                                                        Telephone Number
           West Virginia business, with NO employees
                                                                                        Contact Person

 3.  Date  ﬁrst employee started work in  4. Number of employees working in WV:                                                   5. Date  ﬁrst wages paid in West Virginia:
       West Virginia:
                                                                                                                       __________
                                              Number of employees working in other states:
 _________/__________/__________                                                                                       __________ _________/__________/___________
 6. If the reason for registering is due to the purchase of a business, merger reorganization or change of legal entity, provide the following information; 
    including percent of assets acquired (if needed, attach additional explanation of the transaction):
    a. Percentage of assets acquired from former business: __________%
    b. Date former business was acquired by current business: _________/__________/___________
    c. Unemployment compensation number of former business, if known: _______________________
    d. Predecessor signature: __________________________________________________________
 7. Have you or do you expect to employ at least ONE worker in 20                   8. Have you or do you expect to have a quarterly payroll of $1,500.00?
    di ﬀerent calendar weeks during calendar year?
    YES       NO                                                                         YES       NO
    If YES, what is the earliest month and year this will occur?                        If YES, what is the earliest quarter and year this will occur?
    Month _____________________________  Year_______________                            Quarter _____________________________  Year_______________
 9. FOR EMPLOYERS OF DOMESTIC HELP ONLY:                                            10. For Agricultural operations only:
    Have you or do you expect to have a $1,000 quarterly payroll of                     Have you or will you have 10 or more workers for 20 weeks or more in 
    domestic workers (housekeepers, baby sitters, etc.) in any year?                    any calendar year or have you paid or will you pay $20,000 or more in 
                                                                                        wages during any calendar quarter?
    YES       NO                                                                         YES       NO
    If YES, indicate the earliest quarter and calendar year.                            If YES, indicate the earliest quarter and calendar year.
    Quarter _____________________________  Year_______________                          Quarter _____________________________  Year_______________
 11. Are you liable for Federal Unemployment Tax?                   YES    NO            If YES, in what year did you become liable? _____________________
 12. CERTIFICATION: This report must be signed by owner if business operated as an individual proprietorship, by all members if business is operated 
    as partnership, joint venture or limited liability company; or by an authorized o   cerﬃof an incorporated business.
Date:                        Signature:                                                                                           Title:
Date:                        Signature:                                                                                           Title:
Date:                        Signature:                                                                                           Title:
Date:                        Signature:                                                                                           Title:

                 PART 2: GOVERNMENT ENTITY OR A FEDERAL EXEMPT NON-PROFIT ORGANIZATION
       COMPLETE THIS PART IF YOU ARE EITHER A GOVERNMENT ENTITY OR A FEDERAL EXEMPT NON-PROFIT ORGANIZATION. 
                                  PLEASE FURNISH A COPY OF EXEMPTION LETTER WITH THIS APPLICATION.
 1. If you are a non-pro ﬁt organization with a 501-C3 exemption, have you or do you expect to employ four or more workers in West Virginia in 20 di  erent                 ﬀ
    calendar weeks during a calendar year?  YES                      NO  If YES, what is the earliest month and year the 20th week will occur?
    Month___________ Year___________
 2. Elect options for unemployment compensation coverage: CONTRIBUTIONS_____________________ REIMBURSEMENT__________________
DO NOT WRITE IN THIS SECTION (OFFICE USE ONLY)
 STATE ID NUMBER:                               LIABLE DATE:

 EFFECTIVE DATE:                                PROVISION:                                        *B29202104W*
                                                                                                         B29202104W
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