2. Type of Ownership:
If a corporation, state of incorporation:
If Corporation or LLC, enter N.C. Secretary of State ID No., if applicable:
3. Legal Business or Owner’s Name:
5. Daytime Business Phone:
or Proprietor’s Social Security No.:
4. Trade Name (DBA Name):
1. Federal Employer ID No.:
Mail to: N.C. Department of Revenue, P.O. Box 25000, Raleigh, NC 27640-0100
I certify that, to the best of my knowledge, this application is accurate and complete.
6. Fax Phone:
Other (Identify)
Ofce Use
Proprietorship Corporation LLC Partnership
LLP
Fiduciary
IV. Signature:
Date:Title:
8. Business Location in N.C.:
(Not P.O. Box Number)
Street
City Zip Code
County
9. Is the business located within city or town limits?
11. Mailing Address:
State
10. Number of locations in N.C. Enclose list if more than one.
I. Identifying Information
Street or P.O. Box
City
Zip Code
State
II. Withholding Tax Section
-What kind of business are you engaged in? (Be specic)
12. List responsible persons (President, Treasurer, Chief Financial Ofcer, Manager, Primary Partners, other ofcers, etc.):
-When will you start selling or purchasing items or services subject to N.C. taxes and/or service charge?
Complete to apply for a Sales and Use or Other Applicable Number.
Yes No
-Will your sales or gross receipts be? Retail (to users or consumers) Wholesale (to registered merchants for resale) Both Retail and Wholesale
-Do you make pension payments to N.C. residents?
Yes
No
(You are required to le a return beginning
with the month or quarter you indicate.)
-Do you pay compensation (other than wages to employees) to a nonresident entity or a nonresident individual for personal services performed
in N.C.?
Yes
No
If yes, do you choose to report the pension payment withholding separately? (See instructions)
Yes
No
Name
Title
Social Security No.
Address
-If business is seasonal (six or fewer months),
ll in circles for months employees are paid:
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
-Total amount you expect to withhold each month: Less than $250 (Quarterly) $250 - Less than $2,000 (Monthly) $2,000 or more (Semiweekly)
-Do you pay compensation (other than wages) to an ITIN contractor for services performed in N.C.?
Yes
No
-Do you have employees who are subject to N.C. withholding?
-Date when wages were or will rst be paid in N.C.:Yes
No
(You are required to le a return beginning with the month or quarter you indicate.)
III. Sales & Use Tax and Other Taxes Section
Complete to apply for an Income Tax Withholding Number.
-Will you provide and sell telecommunications and ancillary services?
-Will you provide and sell direct-to-home satellite services?
-Will you provide and sell other video programming services?
-What accounting method will you use?*
-Are you registering only to remit use tax on purchases?
-Will you provide and sell electricity?
-Will you provide motor vehicle leases
or subscriptions?
-Will you sell new tires?
-Will you sell new appliances?
-Will you provide and sell piped natural gas?
Cash
Yes
Yes
Yes
Yes
Yes
Accrual
No
No
No
No
No
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
-If business is seasonal (six or fewer months),
ll in circles for months of sales:
-Amount of sales tax expected each month: Less than $100
(Quarterly) $100 - Less than $20,000 (Monthly) $20,000 or more (Monthly with Prepayment)
*Sales tax on telecommunications and ancillary services, electricity, and piped natural gas must be reported on the accrual basis.
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
-Will you provide and sell prepaid wireless telecommunications services?
If yes, select ling frequency
Business Registration Application for
Income Tax Withholding, Sales and Use Tax,
and Other Taxes and Service Charge
NC-BR
Web-Fill
10-19
7. Email Address:
Semiannual
Monthly
4
PRINT
CLEAR
-
-
-
Form NC-BR Instructions, Web-Fill 10-19
II. Income Tax Withholding
Wages: North Carolina law requires withholding of income tax from salaries and wages of all residents regardless of where earned and from wages of
nonresidents for personal services performed in this State. The tax must be withheld from each payment of wages, and is considered to be held in trust
until it is paid to the Department of Revenue. Due date requirements for reporting and paying the tax depend on the amount of tax withheld each month.
Employers withholding less than $250 per month report and pay quarterly. Employers who, on average, withhold at least $250 but less than $2,000 per
month report and pay monthly. Employers who, on average, withhold $2,000 or more per month make payments on the dates federal deposits are required
and le quarterly reports.
Pension Payments: If you are required to withhold federal tax under section 3405 of the Internal Revenue Code on a pension payment to a N.C. resident,
you must also withhold State income tax unless the recipient elects no withholding. You must withhold on periodic payments as if the recipient is a single
individual with no withholding allowances unless the recipient provides an allowance certicate (Form NC-4P) reecting a different ling status or number
of allowances. For nonperiodic distributions, 4% of the tax must be withheld. Reporting and Paying Pension Withholding: If you already have a
wage withholding identication number, you can report and pay the pension withholding with your wage withholding or you may choose to report and pay
the withholding tax separately. If you choose to pay pension withholding with wage withholding, you do not have to complete this form. However, if you
choose separate reporting of wage and pension withholding, or if you report only pension withholding, you must complete and le this form to obtain a new
identication number.
Compensation Paid to a Nonresident Individual or Nonresident Entity for Personal Services Performed in North Carolina: If you pay non-wage
compensation of more than $1,500 during the calendar year to a nonresident contractor for personal services performed in N.C. in connection with a
performance, an entertainment or athletic event, a speech, or the creation of a lm, radio, or television program, you must withhold N.C. income tax at the
rate of 4% from this non-wage compensation.
Compensation Paid to an ITIN Contractor: If you pay non-wage compensation of more than $1,500 during the calendar year to an ITIN contractor, you
must withhold North Carolina income tax at the rate of 4% from the non-wage compensation. An ITIN contractor is a contractor who performs services in
North Carolina for compensation other than wages and whose taxpayer identication number is an ITIN number instead of a social security number. An
ITIN is issued by the Internal Revenue Services to a person who is required to have a taxpayer identication number but does not have and is not eligible
to obtain a social security number.
Reporting and Paying Withholding from Non-wage Compensation: If you already have a wage withholding identication number, you should report
and pay the non-wage withholding with your wage withholding. If you report only non-wage withholding, you must complete and le this form to obtain
a withholding identication number. For detailed instructions on reporting and paying tax withheld from wages, pensions, and other non-wage
compensation, see Form NC-30, Income Tax Withholding Tables and Instructions for Employers. Form NC-30 is available on the Department’s
website at www.ncdor.gov.
III. Sales and Use Tax and Other Taxes and Service Charge
Every person engaged in business as a retailer or wholesale merchant in this State or a facilitator liable for remittance of sales and use taxes, must obtain
a Certicate of Registration. A Certicate of Registration issued by the Department contains the sales and use account ID issued by the Department.
A Certicate of Registration allows the retailer or wholesale merchant to issue Form E-595E, Streamlined Sales and Use Tax Agreement Certicate of
Exemption, or the required data elements per N.C. Gen. Stat. § 105-164.28, to obtain tangible personal property, certain digital property or certain services
at the time of purchase for resale without paying sales and use tax. A purchaser is liable for a $250.00 penalty for misuse of the Certicate of Exemption
per N.C. Gen. Stat. § 105-236(a)(5a). See Form E-595E instructions for the proper use of the form.
Every business that purchases taxable tangible personal property, certain digital property, or certain services inside or outside this State for storage, use,
or consumption in North Carolina where sales and use tax is not paid to the vendor at the time of purchase is required to obtain a Certicate of Registration
to remit use tax due on the purchase price of such items unless the business is currently registered to remit sales tax.
In addition to items subject to the general State, applicable local, and applicable transit rates of sales and use tax, a person may register in this section
to report and remit tax due on the following: gross receipts derived from sales of electricity or piped natural gas; gross receipts derived from providing
telecommunications services and ancillary services or video programming; motor vehicle lease or subscription receipts; scrap tire disposal; white goods
(appliances) disposal; and prepaid wireless telecommunications service charge.
Business Registration Application Instructions
Step 1 - Complete Section I. Identifying Information. Use blue or black ink to complete this form in its entirety and mail to the Department.
Line 1 Enter your Federal Employer Identication Number. Important: Federal employer identication numbers are required of all partnerships.
If the business is a proprietorship, enter the Social Security Number of the owner.
Line 3 If the business is a sole proprietorship, enter the name of the owner. If the business is a corporation or a LLC, enter the legal name.
The legal name of the N.C. corporation or LLC is the name shown on the Articles of Incorporation or Articles of Organization led with
the Secretary of State. The legal name of an out-of-state corporation or LLC is the name shown on the Certicate of Authority issued by
the Secretary of State. If the business is a partnership, enter the legal name of the partnership and list the partners’ names in Line 12.
Line 4 Enter the trade name by which your business is known to the public.
Line 8 Enter the N.C. address of the actual business location, not the home address of an individual owner or a representative.
Step 2 - Complete Section II. if you are applying for an Income Tax Withholding Number.
Step 3 - Complete Section III. if you are applying for a Certicate of Registration, also known as a Sales and Use Tax Number, or for a Users or Consumers
Use Tax Registration. Section III. allows a person to request registrations for Other Taxes and Service Charge.
Step 4 - Sign and date the application and mail it to N.C. Department of Revenue, P.O. Box 25000, Raleigh, NC 27640-0100. The application must be
signed by the owner, a partner, a corporate ofcer, or another authorized individual. Questions can be directed to 1-877-252-3052. Select the
Other Inquiries option, then the appropriate tax type.
NOTE - The Department will assign you a withholding, sales and use tax, motor vehicle lease and rental tax, scrap tire disposal tax, white goods disposal tax,
prepaid wireless telecommunications service charge account number as appropriate, after this application is processed. Use the assigned number to make
your tax payments. The amount of tax withheld, any sales tax, or any other taxes or service charge on this application collected are deemed by law to be
held in trust by you for the State of N.C. Failure to remit or any misapplication of these funds to the Department of Revenue could result in criminal action.
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