Employer Local Services Tax Registration | www.hab-inc.com

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You are entitled to receive a written explanation of your rights with regard to the audit, appeal, enforcement, refund and collection of local taxes by contacting your Tax Officer.

Employer Information

Employer Business Name (Use Federal ID Name) *

Please use the Federal ID Name

Employer Mailing Address (Address where all forms are to be sent) *

Country

City

State

Zip code

Employer Business Location *

The employees are physically working at the address above

The employees are physically working at a different address than above

Employer Business Location - (Street Address Within PA - No PO Box, RD or RR) *

Country

City

State

Zip code

PSD Code For This Location *

Phone *

Email *

Federal Employer ID Number *

Date Business Started (MM/YYYY) *

Number of Employees (Include Full & Part Time) *

Primary Nature / Operation Of Business

Owner Name 1 (First Name, Last Name) *

Owner Name 2 (First Name, Last Name)

Payroll Contact Name (First Name, Last Name) *

Under penalties of perjury, I (we) declare that I (we) have examined this information, including all accompanying schedules and statement and to the best of my (our) belief, they are true, correct and complete.

Account Number

Please allow 1 business day to add this information to our file.

Would you like your account number emailed to you?

Yes

No

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