Rev. 12/09 
                               Department of                                                         UT 1000 
            hio                Taxation                                                              Application for
                               P.O. Box 182215                                      07100100 
                               Columbus, OH 43218-2215                                               Certifi cate of Registration
                               (888) 405-4089 
                                                                                                     for Out-of-State Sellers 
                                                                                                  Account no. 
                                                                                             (For department use only) 

      Federal employer identifi cation no.                    Social Security no. / ITIN                       Ohio corporate charter 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 providing taxable sales in the state of Ohio? (MM/DD/YY) 
                                                                                                              (For the most current listings, search
   3. Provide NAICS code and state nature of business activity                                                NAICS on our Web site at tax.ohio.gov.) 
   
   4. Legal name
                (Corporation, sole owner, partnership, etc.) 

   5. Trade name or DBA

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

                Business phone no.                                 Fax no.                                    Secondary phone no. 

   7. Mailing address 
                              (If different from above)                                      City                      State           ZIP code 
   8. How much sales tax do you expect to collect each month? Less than $200         $200 or greater        

  9. If you operate as a corporation or partnership, list appropriate names, addresses and identification                     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 
  10. 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 

                                                        Mail 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.