Illinois Department of Revenue REG-1 Illinois Business Registration Application Register faster on-line at tax.illinois.gov. If you are already registered and need to make changes (e.g., adding a location, changing officer information), call us weekdays between 8 a.m. and 5 p.m. at 217 785-3707. Step 1: Identify your business or organization 1 6 Check the organization type that applies to you: Federal employer identification number (FEIN) Proprietorship ____ Check if owned by husband and wife or civil union Partnership Trust or estate Corporation* S Corp (Subchapter S Corporation)* FEIN: ______ - __________________ Proprietorships must provide the Social Security number (SSN) under which taxes will be filed. SSN: _________ - ______ - ____________ 2 * Requires President, Secretary, and Treasurer/Comptroller to be identified in Step 2. Legal business name: ___________________________________________________ 3 Doing-business-as (DBA), assumed, or trade name, if different from Line 2: ___________________________________________________ 4 Governmental unit Not-for-profit organization LLC - Corporation LLC - Partnership LLC - Single member ____ Check if disregarded 7 Illinois Secretary of State identification number: ___ - ___ ___ ___ ___ - ___ ___ ___ - ___ Primary or legal business address: ___________________________________________________ Street address - No PO Box number 8 Is your business part of a unitary group? ___ Yes ___No If “Yes”, provide the FEIN of your designated agent (the entity responsible for filing your Illinois income tax return): Apartment or suite number ___________________________________________________ City State FEIN: ______ - __________________ ZIP If you have other locations in Illinois from where you do business, complete and attach Schedule REG-1-L. 5 9 Identify a contact person regarding your business. Name: __________________________Title:______________ Mailing address if different from the address above: Phone: (______) ______ - ________ Ext.: __________ ___________________________________________________ In-care-of name FAX: ___________________________________________________ Street address or PO Box number (______) ______ - ________ Email address: _____________________________________ Apartment or suite number ___________________________________________________ City State ZIP Step 2: Identify your owners and officers - If you need to identify more, attach Schedule REG-1-O. 10 Each individual or business (i.e., owner, officer, general partner, trustee, executor, and for limited liability company - manager and member) must be identified. Identification depends on the organization type you selected in Step 1, Line 6. Individuals: (include Social Security number (SSN)) a ___________________________________ _________________ Name d Title Name ______________________________________________________ Home address - No PO Box number ___________________________________ _________________ Title ______________________________________________________ ZIP Home address - No PO Box number ____ / ____ / ________ (______) ______ - ________ ____ / ____ / ________ (______) ______ - ________ Date of birth Phone Date of birth Phone City State City State ZIP _______ - _____ - _________ Ownership percentage: ______ b _______ - _____ - _________ Ownership percentage: ______ Social Security number Social Security number ___________________________________ _________________ Name Title Businesses: (include federal employer identification number (FEIN)) a ___________________________________ ____-_____________ ______________________________________________________ Name Home address - No PO Box number ______________________________________________________ City State ZIP FEIN ____ / ____ / ________ (______) ______ - ________ Legal address Date of birth Phone ______________________________________________________ City State ZIP _______ - _____ - _________ Ownership percentage: ______ Social Security number c (______) ______ - ________ ___________________________________ Name Title b ______________________________________________________ Home address - No PO Box number City State ZIP Ownership percentage: ______ Phone _________________ ___________________________________ ____-_____________ Name FEIN ______________________________________________________ Legal address ____ / ____ / ________ (______) ______ - ________ Date of birth Phone ______________________________________________________ City _______ - _____ - _________ Ownership percentage: ______ Social Security number State (______) ______ - ________ Ownership percentage: ______ Phone REG-1 (R-07/12) front ZIP American LegalNet, Inc. www.FormsWorkFlow.com Step 3: Tell us about your business activities 11 Describe your business activities:______________________ ____________________________________________ Cigarettes and other tobacco products Cigarettes - See Schedule REG-1-C before you check here. Provide your North American Industry Classification System (NAICS) number:___________________________________ Refer to the website www.naics.com. Tobacco products - See Schedule REG-1-C before you check here. 12 Will you have Illinois employees? ___ Yes Cigarette machine operator - See Schedule REG-1-C before you check here. When will (did) these activities begin? ____/____/_____ 13 Does your supplier collect Illinois sales tax for Renting or leasing ___ No When will (did) your Illinois payroll begin: ___/___/_____ merchandise your business uses or consumes in Illinois? ___ Yes ___ No When will (did) these activities begin? ____/____/_____ 14 Check all that apply to your type of business. Sales You must complete and attach Schedule REG-1-L to identify all Illinois locations from which you make retail sales. General merchandise: ____ Retail ____ Wholesale Do you estimate your monthly sales tax liability to be over $200? ____ Yes ____ No Sales to Illinois customers from out of state ____ Check here if you have an Illinois presence. Soft drinks (other than fountain soft drinks) in Chicago Vehicle, watercraft, aircraft, or trailers Sales or delivery of tires. Do you always pay the Tire User Fee to your supplier? ___ Yes ___No Sales from vending machines. How many vending machines? ____ Liquor at retail (bar, tavern, liquor store, etc.) Motor fuel/fuel: ____ Retail ____ Wholesale ____ Check here if you are required to collect prepaid sales tax. When will (did) these activities begin? ____/____/_____ Services Do you transfer items, on which tax must be collected, as part of your service? ___ Yes ___ No When will (did) this activity begin? ____/____/_____ You must complete and attach Schedule REG-1-L to identify all Illinois locations from which you rent or lease. Hotel rooms for less than 30 days Do you charge for telecommunication services? ___ Yes ___ No Vehicles for one year or less When will (did) these activities begin? ____/____/_____ Utility providers Electricity: ____ Retail ____ Wholesale Natural gas:____ Retail ____ Wholesale Telecommunications - See Schedule REG-1-T. ____ Retail ____ Wholesale Water or sewer services Are you a utility cooperative? ___ Yes ___ No Are you a municipality? ___ Yes ___ No When will (did) these activities begin? ____/____/_____ All other tax types Liquor warehousing - Attach Schedule REG-1-A. Dry cleaning: ___ Facility ___ Solvent supplier Own/operate coin-operated amusement devices You wish to purchase electricity for non-residential use and pay the tax to IDOR - Attach Schedule REG-1-D. You wish to purchase natural gas from outside of Illinois for your own use and pay the tax to IDOR - Attach Schedule REG-1-G. Not listed. Identify: _______________________ When will (did) these activities begin? ____/____/_____ Step 4: Check any schedule attached (not all applicants are required to complete additional schedules) ˆ Schedule REG-1-L ˆ Schedule REG-1-O ˆ Schedule REG-1-R ˆ Schedule REG-1-T ˆ Schedule REG-1-C ˆ Schedule REG-1-A ˆ Schedule REG-1-D ˆ Schedule REG-1-G ˆ Schedule REG-1-MR Step 5: Sign below 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. I further attest that I will be responsible for filing returns and paying all taxes due unless Schedule REG-1-R, Responsible Party Information, is attached to this application or forwarded to the department. Check here if you are attaching or forwarding Schedule REG-1-R: Signature: _______________________________________ Title: ______________________ Printed name: _______________________________________ SSN: _____-____-_________ Address: _______________________________________ Phone: (_____) ______ - ___________ Mail your completed form, with any required attachments and payment to: Date:___/___/______ CENTRAL REGISTRATION DIVISION 3-222 ILLINOIS DEPARTMENT OF REVENUE PO BOX 19476 SPRINGFIELD IL 62794-9476 This form is authorized by 20 ILCS 687/6-1 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., 155/1 et seq., 415/1 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 20/1 et seq.; 25/1et seq., 30/1et seq.; 235 ILCS 5/1-1 et seq.; 305 ILCS 20/5 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. REG-1 (R-07/12) back This form has been approved by the Forms Management Center. American LegalNet, Inc. www.FormsWorkFlow.com