*B29202101W*
B29202101W
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WV BUS-APP
Rev 01-21
WEST VIRGINIA NEW BUSINESS
REGISTRATION APPLICATION
Register online at business4.wv.gov. Remote sellers are encouraged to use the simplifi ed registration process online at mytaxes.wvtax.gov.
If you are making changes to a business already registered with the WV State Tax Department, do not use this form. Go to mytaxes.wvtax.gov or submit BUS-RBL.
Delays issuing your business license may occur if you fail to submit ALL the pages of this form, fail to complete all required sections, or do not include all required
supporting documentation. Handwritten forms may take longer to process.
PART 1
SECTION A: REASON FOR SUBMITTING THIS APPLICATION Choose only one.
NEW BUSINESS
You do not currently have a business license
issued by the WV State Tax Department for any of
your business activity at any location.
EXISTING BUSINESS OPENING NEW LOCATION
You have a business license issued by the WV State Tax
Department for at least one location but are opening an
additional business location.
WITHHOLDING ONLY (skip page 2)
You only have employees in WV and
will not engage in purposeful revenue
generating activity in this state.
SECTION B: BUSINESS IDENTIFICATION
Sole Proprietors must complete FIRST and LAST NAME and SSN on Line 1A and skip line 1B. All others must skip line 1A and enter LEGAL NAME OF BUSINESS and the BUSINESS FEIN on line 1B.
1A. LEGAL NAME OF SOLE PROPRIETOR FIRST NAME
MIDDLE INITIAL
LAST NAME
SUFFIX
SSN OF SOLE PROPRIETOR
1B. LEGAL NAME OF ENTITY FEIN
2. DBA (Complete Schedule DBA for additional DBAs and trade names)
3.
STREET
ADDRESS LINE 1
STREET
ADDRESS LINE 2
(OPTIONAL)
UNIT
TYPE
UNIT
NUMBER
CITY STATE ZIP
COUNTRY FOR LOCATION ADDRESS COUNTY
IF IN WV, IS THE BUSINESS WITHIN CITY LIMITS
NO YES
4.
MAILING
ADDRESS LINE 1
MAILING
ADDRESS LINE 2
(OPTIONAL)
UNIT
TYPE
UNIT
NUMBER
CITY STATE ZIP
COUNTRY FOR MAILING ADDRESS
5A. EMAIL ADDRESS
5B WEBSITE
6. WILL YOU HAVE
WEST VIRGINIA
EMPLOYEES?
If yes, answer 6A
and 6B
NO YES
6A. DATE YOU WILL BEGIN
WITHHOLDING WV
INCOME
(MMDDYYYY)
6B. NUMBER OF
EMPLOYEES
SUBJECT TO WV
INCOME TAX
6C. TO CONSOLIDATE YOUR
WITHHOLDING TAXES UNDER
AN EXISTING WITHHOLDING
ACCOUNT, ENTER THE EIGHT
DIGIT ACCOUNT NUMBER
Consolidated Withholding
7. DATE BEGINNING
BUSINESS IN WV
(MMDDYYYY)
8. TAXABLE YEAR END
FOR FEDERAL TAX
PURPOSES
(MM)
9. ESTIMATED ANNUAL GROSS INCOME
10.BUSINESS PHONE
area code phone number
.
SECTION C: BUSINESS ACTIVITY
11. DESCRIPTION OF BUSINESS ACTIVITY In detail, explain what your business will do or is doing in WV.
12. NAICS CODES (6 digits preferred)
Provide the North American Industry Classifi cation
System Codes that represents your business
activity. For help, See page Worksheet 1 in the
Instructions.
PRIMARY NAICS SECONDARY NAICS ADDITIONAL NAICS
*B29202102W*
B29202102W
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WV BUS-APP PART 1 continued
Delays issuing your business license may occur if you fail to submit ALL the pages of this form, fail to complete all required sections, or do not include all required supporting documentation.
SECTION C : BUSINESS ACTIVITY CONTINUED
13. GENERAL ACTIVITY - Select all that apply. Must select at least one. Certain activities require additional documentation as noted. If you only have
employees in WV and will not engage in purposeful revenue generating activity in West Virginia, leave this page blank.
See Instructions for more information.
SALES AND SERVICES - Sell tangible personal property, provide services or conduct maintenance work from a WV location or to Customers in WV.
IF YOU WILL BE CONSOLIDATED FILING SALES AND SERVICE TAX UNDER AN EXISTING SALES
TAX ACCOUNT, PLEASE ENTER THE EIGHT DIGIT WV SALES TAX ACCOUNT NUMBER HERE:
Which of the following goods, services, or maintenance work do you provide?
BEER- Will you hold a license to sell beer to
licensed beer distributors or retailers
WINE- you will sell wine to licensed wine
distributors or retailers or WV registered
wine suppliers
CONSTRUCTION- make alterations, repairs, improvements, and decorations
to real property and structures that constitute capital improvements. For further
information on what constitutes a capital improvement,consult TSD-310.
WINE/LIQUOR - As a retailer, will you hold a
license to sell liquor and/or wine by the bottle?
(Not sold in clubs, bars, or restaurants)
You will sell alcohol as a private club, bar,
or restaurant
NON-RESIDENT CONTRACTOR
Must be properly bonded and fi le an itemized listing of equipment and materials
brought into West Virginia for use in contracting activity.
MANUFACTURING
COLLECTION AGENCY
Attach CAB-1. Must be properly bonded
SOFT DRINK
PRODUCTS
BOTTLER
SOFT DRINK
PRODUCTS
WHOLESALER
SOFT DRINKS PRODUCTS CROWN
MANUFACTURER (bond required)
TELEMARKETING to WV residents
Attach form TLM and Corporate Surety Bond. Must be properly bonded
SOFT DRINKS RETAILER purchases from a
bottler or wholesaler without excise tax paid
SOFT DRINKS RETAILER purchases from a
bottler or wholesaler with excise tax paid
EMPLOYMENT AGENCY
Attach letter from the Commissioner of labor
FIREWORKS
Must be licensed by the State Fire Marshal
MAKE CONSUMER OR SUPERVISED LOANS
Attach BUS-CSL
DRUG PARAPHERNALIA
Attach forms DRUG 1 and DRUG 2. Pay Additional Fee.
PRENEED CEMETERY
Attach CEM-1 and CEM-B
TRANSIENT VENDOR-Sell tangible personal property to consumers at retail level and do not
maintain an established place of business in West Virginia
Attach TVL-1. $500 bond or certifi ed check required.
OPERATE NATURAL GAS STORAGE
RENTAL
PROVIDE ELECTRIC
POWER
SCRAP METAL DEALER OR RECYCLER
PUBLIC UTILITIES regulated by the PSC
SOLID WASTE
OTHER SALES, SERVICE, OR MAINTENANCE NOT LISTED.
TOBACCO PRODUCTS
Mark all products you will sell (must select at least one): Mark which describes you (must select at least one)
CIGARETTES OTHER TOBACCO
PRODUCTS
E-CIGARETTE LIQUIDS MANUFACTURER WHOLESALER RETAILER
NATURAL RESOURCES- hold title to or economic interest in severing, reducing to possession and producing for sale, profi t or commercial use, any natural
resource product (unless only for royalties) A permit from Department of Environmental Protection also required
TIMBERING
Requires Division
of Forestry permit
COAL - producer COAL - processor
NATURAL GAS
LIMESTONE SANDSTONE
OIL
OTHER
RESOURCES
FUEL - purchase, import, export, refi ne, or transport motor fuel in WV meant for sale or profi t.
Attach WV/MFT-APP
COMMON CARRIER - operate aircraft, watercraft or locomotives that transport freight or passengers within West Virginia.
HEALTHCARE - provide health care services (only includes ambulances, practitioners, hospitals, nursing home care, and x-rays)
MEDICAL CANNABIS - grow/produce or dispense medical cannabis
Requires license from Offi ce of Medical Cannabis
GROWER PROCESSOR DISPENSARY
FARMING
USE COMMERCIAL WEIGHING OR MEASURING DEVICES
Must register with Division of Labor
OTHER/ACTIVITY NOT LISTED
*B29202103W*
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WV BUS-APP PART 1 continued
Delays issuing your business license may occur if you fail to submit ALL the pages of this form, fail to complete all required sections, or do not include all required supporting documentation.
SECTION D: BUSINESS OWNERSHIP
14. OWNERSHIP TYPE select at least one of the options below.
IF YOU ARE A CORPORATION,
CHOOSE ONE BELOW:
IF YOU ARE NOT A PARTNERSHIP OR A CORPORATION,
CHOOSE ONE BELOW:
SOLE PROPRIETOR
DOMESTIC CORPORATION LIMITED LIABILITY COMPANY
IF YOU ARE A PARTNERSHIP, CHOOSE
ONE BELOW:
SINGLE MEMBER LLC
FOREIGN/OUT OF STATE
CORPORATION
GENERAL PARTNERSHIP
TREATED AS A S CORPORATION
If S Corporation, check the box and enter fi rst year to
which the S status applies (YYYY)
LIMITED PARTNERSHIP
TREATED AS A C CORPORATION
If applicable, enter date when your partnership
elected not to be treated as a partnership
under Internal Revenue Code Section 761
(MMDDYYYY)
JOINT VENTURE
Will you fi le your corporate income tax returns in WV on
a combined basis under a parent? If so, enter parent’s
FEIN and Name.
ASSOCIATION
CHARITABLE ORGANIZATION
FEIN
A copy of the IRS 501-C determination is required. Failure to submit a
copy will result in this business not being granted the exemptions given
to an organization performing charitable activity.
NAME
OTHER (specify):
SECTION E: RESPONSIBLE PARTY
Complete a line for each responsible party who is an owner, partner, member, corporate offi cer, or trustee. There must be at least one individual who is a responsible party. Please list this person on line 15.
In the case of a sole proprietorship, provide owner information in line 15. In the case of a partnership, provide information for each general partner.
Attach an additional page if needed.
Each person listed will be considered to have authority to speak for and act on the behalf of the business when dealing with the WV State Tax Department. To grant authority to act on behalf of the business
to an individual who is NOT an owner, partner, member, corporate offi cer, or trustee; complete the WV-2848 Authorization of Power of Attorney. See instructions for additional information.
15
FIRST
NAME
LAST
NAME
TITLE SSN
EMAIL
EFFECTIVE DATE
MMDDYYYY
PHONE NUMBER
WITH AREA CODE
16
FIRST
NAME
LAST
NAME
TITLE SSN
EMAIL
EFFECTIVE DATE
MMDDYYYY
PHONE NUMBER
WITH AREA CODE
17
FIRST
NAME
LAST
NAME
TITLE SSN
EMAIL
EFFECTIVE DATE
MMDDYYYY
PHONE NUMBER
WITH AREA CODE
18
FIRST
NAME
LAST
NAME
TITLE SSN
EMAIL
EFFECTIVE DATE
MMDDYYYY
PHONE NUMBER
WITH AREA CODE
SECTION F : SIGNATURE
THIS REGISTRATION FORM MUST BE SIGNED BY A RESPONSIBLE PARTY WHO IS AUTHORIZED TO SIGN ON BEHALF OF THE ORGANIZATION.
THE PROPRIETOR MUST SIGN FOR A SOLE PROPRIETORSHIP.
Under penalty of perjury, I declare that I have examined this application, accompanying documents, and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Signature of Offi cer/Partner or Member Print name of Offi cer/Partner or Member Title Date
A $30.00 registration tax is due with this application with the exception of: charitable organizations, government agencies,
agricultural/farming activities or a “withholding only” account.
For this application to be valid and to avoid a delay in processing, all pages must be completed and application signed.
This application may be photocopied as proof of registration until your Certifi cate(s) are issued.
AMOUNT DUE
$ 30.00
MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
TAX ACCOUNT ADMINISTRATION DIVISION
REGISTRATION & ACCOUNT CORRECTION UNIT
PO BOX 2666
CHARLESTON WV 25330-2666
*B29202104W*
B29202104W
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PART 2 :UNEMPLOYMENT COMPENSATION
SECTION E: UNEMPLOYMENT COMPENSATION
COMPLETE THIS SECTION TO REGISTER FOR AN UNEMPLOYMENT COMPENSATION ACCOUNT.
All new businesses are required to complete this section, even if they have no employees in West Virginia
1. Reason for applying:
New Business
Additional Location
Purchased Business
Out of State Business, registering for Withholding Only
West Virginia business, with NO employees
2. Name, street address, telephone number and person to contact where
payroll records are maintained:
Name
Address
City State Zip Code
Telephone Number
Contact Person
3. Date fi rst employee started work in
West Virginia:
_________/__________/__________
4. Number of employees working in WV:
__________
Number of employees working in other states:
__________
5. Date fi rst wages paid in West Virginia:
_________/__________/___________
6. If the reason for registering is due to the purchase of a business, merger reorganization or change of legal entity, provide the following information;
including percent of assets acquired (if needed, attach additional explanation of the transaction):
a. Percentage of assets acquired from former business: __________%
b. Date former business was acquired by current business: _________/__________/___________
c. Unemployment compensation number of former business, if known: _______________________
d. Predecessor signature: __________________________________________________________
7. Have you or do you expect to employ at least ONE worker in 20
diff erent calendar weeks during calendar year?
YES
NO
If YES, what is the earliest month and year this will occur?
Month _____________________________ Year_______________
8. Have you or do you expect to have a quarterly payroll of $1,500.00?
YES
NO
If YES, what is the earliest quarter and year this will occur?
Quarter _____________________________ Year_______________
9. FOR EMPLOYERS OF DOMESTIC HELP ONLY:
Have you or do you expect to have a $1,000 quarterly payroll of
domestic workers (housekeepers, baby sitters, etc.) in any year?
YES
NO
If YES, indicate the earliest quarter and calendar year.
Quarter _____________________________ Year_______________
10. For Agricultural operations only:
Have you or will you have 10 or more workers for 20 weeks or more in
any calendar year or have you paid or will you pay $20,000 or more in
wages during any calendar quarter?
YES
NO
If YES, indicate the earliest quarter and calendar year.
Quarter _____________________________ Year_______________
11. Are you liable for Federal Unemployment Tax?
YES
NO If YES, in what year did you become liable? _____________________
12. CERTIFICATION: This report must be signed by owner if business operated as an individual proprietorship, by all members if business is operated
as partnership, joint venture or limited liability company; or by an authorized offi cer of an incorporated business.
Date: Signature: Title:
Date: Signature: Title:
Date: Signature: Title:
Date: Signature: Title:
PART 2: GOVERNMENT ENTITY OR A FEDERAL EXEMPT NON-PROFIT ORGANIZATION
COMPLETE THIS PART IF YOU ARE EITHER A GOVERNMENT ENTITY OR A FEDERAL EXEMPT NON-PROFIT ORGANIZATION.
PLEASE FURNISH A COPY OF EXEMPTION LETTER WITH THIS APPLICATION.
1. If you are a non-profi t organization with a 501-C3 exemption, have you or do you expect to employ four or more workers in West Virginia in 20 diff erent
calendar weeks during a calendar year?
YES
NO If YES, what is the earliest month and year the 20th week will occur?
Month___________ Year___________
2. Elect options for unemployment compensation coverage: CONTRIBUTIONS_____________________ REIMBURSEMENT__________________
DO NOT WRITE IN THIS SECTION
(
OFFICE USE ONLY
)
STATE ID NUMBER: LIABLE DATE:
EFFECTIVE DATE: PROVISION:
