ST 1T
Application for
Transient Vendor's License
Rev. 9/19
Address of corporation, sole owner, partnership, etc. City State ZIP code
(If dierent from above) City State ZIP code
Vendor license no.
(For department use only)
P.O. Box 182215
Columbus, OH 43218-2215
(888) 405-4089
07100100
Federal Employer Identication Number Social Security Number / ITIN
Business phone number Fax number Secondary phone number
SSN / ITIN / FEIN
SSN / ITIN / FEIN
(For the most current listings, search
NAICS on our Web site at tax.ohio.gov.)
(Corporation, sole owner, partnership, etc.)
Name
Phone number Fax number
E-mail address
account.
SSN / ITIN / FEIN
Title Name Street City State ZIP code
Title Name Street City State ZIP code
Title Name Street City State ZIP code
Fee for this license - $25 (made payable to Ohio Treasurer of State). Send the original application and $25 fee to
the address above
Federal Privacy Act Notice
Because we require you to provide us with a Social Security number, the Federal Privacy Act of 1974 requires us to inform you that providing
us with your Social Security number is mandatory. Ohio Revised Code sections 5703.05, 5703.057 and 5747.08 authorize us to request
this information. We need your Social Security number in order to administer this tax.
Secretary of State Entity Number
1. Check type of ownership: Sole owner Partnership Corporation Nonprot LLC LLP LTD
Single member LLC Other (please specify)
2. When did you or will you begin providing taxable sales in the state of Ohio? (MM/DD/YY)
3. Are you obtaining this license to make sales at a temporary place of business in a county in which you have no xed
place of business? Yes No
4. Provide NAICS code and state nature of business activity
5. Legal name
6. Trade name or DBA
7. Primary address
8. Mailing address
9. How much sales tax do you expect to collect each month? Less than $200 $200 or greater
10. If you operate as a corporation, LLC, or partnership, list appropriate names, addresses and identication numbers below.
11. Name, phone number, fax number and e-mail address of individual the department should contact regarding this
Date Signature of applicant
