Employer Registration For Business Privilege Tax, Mercantile Tax, Payroll Preparation Tax | www.hab-inc.com

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If you operate a business in a municipality and/or school district in which a Business Privilege, Mercantile Tax and / or Payroll Preparation Tax has been levied on gross receipts, you are required to answer the following questions in order to comply with Act 511 of the Pennsylvania State Legislature (and the law in your local taxing district). All information will be held in strict confidence.

Note: By completing and submitting this form, we will add an account to our file for your business, however, the tax cannot be filed or paid online.

Business Information

Name of Business *

Federal EIN or Social Security # *

Business Address Or Rental Property Address *

Country

City

State

Zip code

Address to Which Forms Should be Mailed

Country

City

State

Zip code

Taxing Jurisdiction *

Municipality, Borough or City, School District & County where the business is located

Business Owner (First Name & Last Name) *

Contact Person (First Name & Last Name)

Date Business Operations Began or Will Begin *

Phone *

Fax

Email *

Type of Business *

If your business is currently filing the Business Privilege Tax, Mercantile Tax or Payroll Preparation Tax with Berkheimer, please indicate your Account Number:

Account Number

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