Information about http://www.archonstl.org/31/IDOR-register.pdf
Illinois Department of Revenue REG-1 …
Tags: business registration, business tax, department of revenue, eff, employer identification number, federal employer identification, federal employer identification number, federal employer identification number fein, illinois business, illinois department of revenue, iltax com, organizational change, registered business, registration application, step 1, time registration,Pages: 4
Language: english
Created: Tue Nov 30 00:00:00 -1
Display cached document
Page 1
Page 2
Page 3
Page 4
Illinois Department of Revenue
REG-1 Illinois Business Registration Application Station # 925
Step 1: Read this information first Do not check here
You may electronically file this form at www.ILtax.com. until you have read
To update previously submitted information, call 217 785-3707. all of Step 4.
Step 2: Provide your identification numbers and the reason for your application
Check the best description of why you are completing this application.
First-time registration of your business or organization. Tell us your federal employer identification number (FEIN). If you
have applied for but not yet received your FEIN, write "applied for." __ __-__ __ __ __ __ __ __
Starting date of this business in Illinois: ____/____/________
Month Day Year
Re-applying of a previously registered business. Tell us the Illinois Business Tax number (IBT no.) and, if applicable, the
license number (Lic. no.) assigned to this business. IBT no.:__ __ __ __-__ __ __ __ Lic. no.: _______________
New starting date of this business in Illinois: ____/____/________
Month Day Year
Organizational change requiring a new Federal Employer Identification number (FEIN).
What is the effective date of this change? ____/____/________
Month Day Year
Is this change the result of a merger or consolidation? yes no
Tell us the FEIN and Illinois Business Tax number (IBT no.) previously assigned when you registered this business.
FEIN: __ __-__ __ __ __ __ __ __ IBT no.:__ __ __ __-__ __ __ __
Tell us the new FEIN assigned to your business as a result of this change. If you have applied for and not yet received your
FEIN, write "applied for." FEIN: __ __-__ __ __ __ __ __ __
Add a tax requirement or location for a currently registered business. Tell us the Illinois Business Tax number (IBT no.)
and federal employer identification number (FEIN) currently assigned to this business.
IBT no.:__ __ __ __-__ __ __ __ FEIN: __ __-__ __ __ __ __ __ __
What is the effective date of this update or addition? ____/____/________
Month Day Year
Step 3: Identify your business or organization
1 Business' or organization's legal name:
______________________________________________________________________________
Corporate, organization, partnership, or owner's (if sole proprietor) name
2 Doing business as (DBA) or trade name (if different from above):__________________________________________________________
3 Address of your corporate/home office or your principal Illinois business address. The address where you can be contacted.
__________________________________________________________________________________________________
Street address Apartment or suite number
__________________________________________________________________________________________________
City State ZIP
(___)____ - _____________ _____ (___)____ - _____________ ___________________________
Daytime phone (include area code) Extension Fax (include area code) E-mail address
4 Did you buy this business from someone? yes no
If yes, write the previous business' name and IBT no.
____________________________________________________________________________ __ __ __ __-__ __ __ __
Previous business' name Previous business' IBT#
5 Check one to indicate your type of business ownership (using the federal income tax classification).
Sole proprietorship. Is this jointly owned by both husband and wife? yes no
Corporation (other than an exempt organization)
Tell us the Illinois Corporate File (charter) number issued by the Illinois Secretary of State:_______________________________
Is this a small business corporation (subchapter S)? yes no If yes, tell us how many shareholders. __________
Partnership. Write the number of general partners.________________
Trust or estate
Exempt organization
Governmental agency
(REG-1 N-1/00) Page 1 of 4
Step 4: Describe your business type or activity
1 Describe your business and provide the percentage of each activity used in your description.
______% _____________________________________________________________________________________________
______% _____________________________________________________________________________________________
2 Check all that apply to your type of business:
Withholding (employees, dividends, or certain winnings) - You pay wages, taxable dividends, or wagering transactions in
Illinois; or, you pay wages to Illinois residents under your state's income tax reciprocity agreement with Illinois.
Sales - You sell merchandise. Are all of your sales for resale or otherwise exempt from sales tax? yes no
Check any that apply to your type of retail sales (if applicable).
Vehicles, trailers, mobile homes, watercraft, aircraft Items sold from vending machines.
Tires How many machines will you have? _____________
Beverages (soft drinks) in closed or sealed containers Solvents sold to dry cleaners
Motor fuel (e.g., gasoline, gasohol, diesel fuel)
Do your sales include purchase orders accepted outside of Illinois and items shipped directly into Illinois? yes no
If "yes," check the best description of your business.
Located in Illinois, including but not limited to an office or agent.
No location in Illinois but will voluntarily collect sales tax on receipts from sales into Illinois.
Use - You buy items for use in Illinois on which you do not pay the Illinois sales tax to your supplier. This includes items from
your inventory bought tax-free for your own use.
Services - You provide services (e.g., repairs, printing, funeral, consulting, barber) and you are not a public utility.
Do you transfer or sell items (e.g., parts, paper, chemicals, shampoo) with your service? yes no
Motor vehicle renting - You are in the business of renting motor vehicles (i.e., automobiles, motorcycles, certain vans/
recreational vehicles) for one year or less.
Water or sewer utility services - You provide water or sewer utility service in Illinois.
Hotel/motel operators - You rent, lease, or let rooms to the public for living quarters for periods of less than 30 days.
Liquor warehousing (not liquor sales) - You warehouse or deliver alcoholic liquors for compensation.
Methane gas landfills - You are a Qualified Solid Waste Energy Facility (QSWEF).
Below are tax responsibilities that may require additional information. We will contact you for this information. If you
check any of the boxes below, please check the "Additional Requirements" box in Step 1 on the front of this application.
Natural gas - You sell natural gas, provide natural gas services to persons in Illinois, or purchase natural gas from outside of
Illinois for your own use (not for resale). Check all that apply.
How do you sell natural gas or natural gas services? at retail at resale
Are you a municipal utility? yes no
Do you purchase natural gas from outside of Illinois for your own use (not for resale) and want to pay the tax directly to us?
yes no
Telecommunications - You provide telecommunications services in Illinois. How do you sell your service? Retail Resale
Is the only service you provide a paging or wireless service? yes no
Cigarette or tobacco products - You manufacture, wholesale, or distribute cigarettes or tobacco products.
Check all that apply to your business' activities.
Cigarette: Manufacture Stamp Distribute
Tobacco products: Distribute Retail (purchase from distributors and tax is not or will not be paid)
Motor fuel, aviation fuels and kerosene - Check the activities which apply to your business.
Distributor - not from retail outlets Compressed gas sales - highway use only Bulk storage plants - not at retail outlets
Retail outlet only Manufacturing Gas/motor fuel blending Importing Exporting
Electricity services - You deliver electricity to persons in Illinois for their own use.
How do you sell your service? Retail Resale
Check any that apply to your type of business:
Electric cooperative Municipal utility
Self-assessing purchaser of electricity for nonresidential use who elects to pay the Electricity Excise Tax directly to us.
Gaming events - You operate gaming (i.e., bingo, charitable games, pull tabs) events or are a premise provider, supplier, or
manufacturer of equipment used during gaming events. Check all that pertains to your organization or business.
organization operating an event supplier or manufacturer of gaming equipment premise provider for events
Page 2 of 4 (REG-1 N-1/00)
Step 5: Describe your business
1 Check all that apply to your Illinois business activity. ___ Retail ___ Wholesale ___ Service ___ Manufacturing/production
2 Check all that apply to your type of business.
Advertising, business services Furniture, flooring, appliances Not-for-profit business/organization
Auto supplies Gasoline, other petroleum products Nursery, florists, garden supplies
Books, jewelry, gifts, cameras Grocery items Other manufacturing not listed: ___________
Building trades, construction, contractors Hardware Other retail not listed: ________________
Other services not listed: ______________
Clothing and accessories Homes - mobile/modular
Other wholesale not listed: ____________
Coin-operated amusement devices Hotel/motel
Paper, textiles, printing, chemicals
Communication Leasing/renting equipment
Pharmaceuticals/drug stores
Computers/programming/design/software Liquor
Public administration, government
Dental, medical services/facilities Lumber, building materials
Real estate, insurance, finance
Dept. store/general merchandise Machines, parts, equipment Renting vehicles
Drinking places Mail order, direct/vending sales Sporting goods, bicycles, toys
Eating places Medical supplies Tobacco products
Electric Metals, rubber, plastic Transportation
Electronics, TVs, music, instruments Mining, coal, other minerals Vehicles, boats, motorcycles
Forestry, livestock, agriculture, fishing Natural gas Water, sewer
Step 6: Identify your business location
Do not complete this step unless your location is in Illinois and your business activities include sales (including vehicle sales), use, service,
hotel/motel operations, telecommunications, motor vehicle renting, electricity services, natural gas, or liquor warehousing. Write your
business name, address (even if it is the same as identified in Step 3), and the date the location started doing business. Note: Township
information is required for all Madison or St. Clair County locations in Illinois.
Location 1: Is this the same address as the address in Step 3? yes no
Check all that apply to this location's type of activity.
Sales, Use, Service Motor vehicle renting Telecommunications Electricity services
Vehicle sales Liquor warehousing Hotel/motel operator Natural gas
Name:__________________________________________________________________ Starting date:___/___/________
Doing business as (DBA) or trade name if different from the name you provided in Step 3 Month Day Year
_______________________________________________________________________________________________________
Street address (Do not use PO Box), include apartment or suite number (if applicable)
Illinois
_______________________________________________________________________________________________________
City State ZIP
County: _______________ Township: ________________ (___)____-_______ Ext:_____ (___)____-__________
Daytime phone (include area code) Fax (include area code)
a Check the best physical description of this location: permanent one that will change (e.g., fairs, flea market)
b Check the best description of this location in regards to the city, village, or town limits listed above: inside outside
Location 2:
Check all that apply to this location's type of activity.
Sales, Use, Service Motor vehicle renting Telecommunications Electricity services
Vehicle sales Liquor warehousing Hotel/motel operator Natural gas
Name:__________________________________________________________________ Starting date:___/___/________
Doing business as (DBA) or trade name if different from the name you provided in Step 3 Month Day Year
_______________________________________________________________________________________________________
Street address (Do not use PO Box), include apartment or suite number (if applicable)
Illinois
_______________________________________________________________________________________________________
City State ZIP
County: _______________ Township: ________________ (___)____-_______ Ext:_____ (___)____-__________
Daytime phone (include area code) Fax (include area code)
a Check the best physical description of this location: permanent one that will change (e.g., fairs, flea market)
b Check the best description of this location in regards to the city, village, or town limits listed above: inside outside
Additional locations:
Check if you need to identify more locations. Attach a separate sheet containing all of the required information in a similar format.
Tell us your total number of Illinois locations. ____________
(REG-1 N-1/00) Page 3 of 4
Step 7: Identify your officers and owners
1 If your business is a corporation, subchapter S corporation, or nonprofit organization, print the legal name and SSN of each officer.
___________________________________________________________________________
President ______ - _____ - ______
Legal name (Last, first, middle initial) SSN
___________________________________________________________________________
Vice-President ______ - _____ - ______
Legal name (Last, first, middle initial) SSN
___________________________________________________________________________
Secretary ______ - _____ - ______
Legal name (Last, first, middle initial) SSN
___________________________________________________________________________
Treasurer/Comptroller ______ - _____ - ______
Legal name (Last, first, middle initial) SSN
2 Is your business a limited liability company? yes no
If yes, attach a list designating each manager and member by name and SSN or FEIN.
3 If your corporation is owned (over 50 percent) by another business, print the legal name and FEIN of the owning entity.
___________________________________________________________________________ _____ - ______________
Owning entity name FEIN
4 If your business is a sole proprietorship, trust/estate, or partnership, provide the legal name and SSN or FEIN of each owner, trustee/
executor, or general partner. Note: If you need to identify more, attach additional sheets with the required information in a similar format.
___________________________________________________________________________ ______ - _____ - ______
Legal name (Last, first, middle initial) SSN
___________________________________________________________________________ ______ - _____ - ______
Legal name (Last, first, middle initial) SSN
___________________________________________________________________________ _____ - ______________
Business name of your owner FEIN
Step 8: Tell us your mailing address
Complete this information only if you want your tax forms and correspondence mailed to an address other than the one listed in Step 3.
Note: All notices and bills (containing confidential tax information), refunds, certificates, and tax forms will be sent to this address.
______________________________________________ _______________________________________________
In-care-of name. Please print. Street address
_________________________________________________________________________________________________
City State ZIP
Step 9: Sign below
1 Person responsible for filing returns and paying taxes: If in Step 4, "Withholding," "Sales," "Use," "Service," "Motor vehicle
renting," or "Hotel/motel" was checked, the person(s) that will be personally responsible for filing returns and paying the tax due must
complete the following information. This signature is required in addition to the signature in Item 2 of this step. The same person can
sign both statements. Note: If you need to identify more, attach sheets with the required information in a similar format.
Check tax responsibility(ies): Withholding Sales, Use, or Services Motor vehicle renting Hotel/motel
______________________________________ ___/___/______ _________________________________________ ______ - _____ - ______
Signature Month Day Year Printed name (Last, first, middle initial) SSN
_________________________________________________________________________________________________
Street address City State ZIP
Check tax responsibility(ies): Withholding Sales, Use, or Services Motor vehicle renting Hotel/motel
______________________________________ ___/___/______ _________________________________________ ______ - _____ - ______
Signature Month Day Year Printed name (Last, first, middle initial) SSN
_________________________________________________________________________________________________
Street address City State ZIP
2 This must be completed by the person completing this application and verifying the information. Signature stamps are not acceptable.
Under penalties of perjury, I state that I have examined this information and, to the best of my knowledge, it is true, correct, and complete.
______________________________________ _________________ ___/___/______ _______________________________
Signature Title Month Day Year Printed name (Last, first, middle initial)
Step 10: Mail your application
If you attached additional sheets for any step in this application, please check here.
If you have any questions or need help completing your application, please call us weekdays between 8 a.m. and 5 p.m.
Email: centreg@revenue.state.il.us Phone: 217 785-3707 Mail: CENTRAL REGISTRATION DIVISION
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19476
SPRINGFIELD IL 62794-9476
This form is authorized by 20 ILCS 687/6 et seq.; 35 ILCS 5/1et seq.,105/1et seq., 110/1et seq., 115/1et seq., 120/1et seq., 130/1et seq., 135/1 et seq., 143/10-1et seq., 415/1 et seq., 155/1 et seq., 505/1et seq., 510/1et seq.,
615/1et seq., 620/1 et seq., 625/1et seq., 630/1et seq., 635/1et seq.; 640/2-1 et seq.; 230 ILCS 25/1et seq., 30/1et seq., 20/1 et seq.; 235 ILCS 5/1-1 et seq.; 305 ILCS 20/5 et seq., 687/6-1 et seq.; 415 ILCS 125/301et seq.;
Disclosure of this information may be REQUIRED. Failure to provide information could result in this form not being processed and possible penalties. This form has been approved by the Forms Management Center. IL-492-0001
Page 4 of 4 (REG-1 N-1/00)