RTS-10
                                                                                                                             R. 01/13
                                                                                                                             TC
                                                                                                                             Rule 73B-10.037
                                                                                                 Florida Administrative Code
                                        Florida Department of Revenue                                    Effective Date 11/14
                                        Reemployment Tax*
                                        Agent/Client Change Form

 Agent Name:                            Contact:

 Mailing Address:                       Title:

 Agent Number (5 digits):               Phone:

 FEIN:                                  Fax:

Use this form to add or delete clients for the purpose of filing or paying reemployment tax.

                                                                                            ADD                              DELETE
 Client Name and Mailing Address        RT                    FEIN                          *Effective   **Effective 
                                        Account No.                                         Begin Date End Date

*Effective Begin Date is the date you begin representing your client.  This date must be the beginning of a reporting period 
(i.e., 1/1/07, 4/1/07, 7/1/07, 10/1/07).
**Effective End Date is the last day of the reporting period for which you represent the client (i.e., 3/31/07, 6/30/07, 9/30/07, 12/31/07).
 Signature of Agent:                                                                        Date:

Mail to: Account Management                                                                 For more information call
         Florida Department of Revenue                                                      850-488-6800.
         PO Box 6510
         Tallahassee, FL  32314-6510
* Formerly Unemployment Tax             www.floridarevenue.com

                                                                                                                             RTS-10
                                                                                                                             R. 01/13
                                                                                                                             Page 2

                                                                                 ADD                                         DELETE
Client Name and Mailing Address         RT                    FEIN               *Effective **Effective 
                                        Account No.                              Begin Date End Date

*Effective Begin Date is the date you begin representing your client.  This date must be the beginning of a reporting period 
(i.e., 1/1/07, 4/1/07, 7/1/07, 10/1/07).
**Effective End Date is the last day of the reporting period for which you represent the client (i.e., 3/31/07, 6/30/07, 9/30/07, 12/31/07).
                                        (Attach additional sheets, if necessary.)

                                        www.floridarevenue.com