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                                                                                                             Rev. 12/09
                              Department of                                                 ST 1T
          hio                 Taxation
                                                                                            Application for
                              P.O. Box 182215                    07100100
                              Columbus, OH 43218-2215                                       Transient Vendor's License 
                              (888) 405-4089
                                                                                    Vendor's license no.
                                                                                    (For department use only)

    Federal employer identifi cation no.                Social Security no. / ITIN           Ohio corporate charter no. / certifi cate no.

   1.  Check type of ownership:  (10) Sole owner        (20) Partnership        (30) Corporation        (150) Nonprofi t           
     (50) LLC        (70) LLP        (80) LTD        Other (please specify)       
   
    2. When did you or will you begin making taxable sales in Ohio? (MM/DD/YY)    
   
    3.  Are you obtaining this license to make sales at a temporary place of business in a county in which you have 
   no fi xed place of business?  Yes        No
                                                                                                             (For the most current listings, search 
   4. Provide NAICS code and state nature of business activity                                       NAICS on our Web site at tax.ohio.gov.)
  
   5. Legal name 
          (Corporation, sole owner, partnership, etc.)
    6. Trade name or DBA

    7. Primary address
                              Address of corporation, sole owner, partnership, etc. City                     State              ZIP code

          Business phone no.                                     Fax no.                                     Secondary phone no.
    8. Mailing address
                             (If different from above)                              City                     State              ZIP code
   9. How much sales tax do you expect to collect each month? Less than $200        $200 or greater

 10. If you operate as a corporation or partnership, list appropriate names, addresses and identifi cation numbers below.
  
   Title         Name                         Street             City                State  ZIP code               SSN / ITIN / FEIN

   Title         Name                         Street             City                State  ZIP code               SSN / ITIN / FEIN

   Title         Name                         Street             City                State  ZIP code               SSN / ITIN / FEIN

 11. Name, phone number, fax number and e-mail address of individual the department should contact regarding this ac-
   count  

   Name                                                Phone no.                    Fax no.                  E-mail address

 Date                         Signature of applicant

   Fee for this license – $25 (made payable to Ohio Treasurer of State). Send the original application and $25 fee to 
   the address above.

    Federal Privacy Act Notice
Because we require you to provide us with a Social Security number, the Federal Privacy Act of 
1974 requires us to inform you that providing us with your Social Security number is mandatory. 
Ohio Revised Code sections 5703.05, 5703.057 and 5747.08 authorize us to request this informa-
tion. We need your Social Security number in order to administer this tax.