AUDITOR

APPLY FOR A VENDOR'S LICENSE

This page is designed to help you apply for a Retail Vendor's license.
Please fill in the fields shown below and then click on the Display Completed Application Form button.

* is Required

Federal Employer ID Nbr: enter as 99-99999999

Social Security Nbr: enter as 999-99-9999

Ohio Charter Nbr:

Ohio Certificate Nbr:

Ohio Master Nbr: enter as 99-99999999

1. Type of Ownership: *

2. When did, or will you start making taxable sales: * enter as mm/dd/yyyy

3. Provide NAICS Code: *

    State nature of business activity: *

4. Legal Name:

5. Business, Trade or DBA Name: *

6. Home Office Address: *

    Home Office Phone: enter as 999-999-9999

    Home Office Fax: enter as 999-999-9999

7. Business Address: *

    Business Phone: enter as 999-999-9999

    Business Fax: enter as 999-999-9999

8. Mailing Address:

9. How much sales tax do you expect to collect each month?: * $200 or greater Less than $200

10. Previous Owner's Name & Address:

     Previous Vendor's Nbr:

11. Will you be selling beer, wine or liquor at this location?: Yes No

     If yes, list your Liquor Control Permit Class:

     If yes, list your Liquor Control Permit Number:

     Employer Withholding Nbr: enter as 99-99999999

12. Do you intend to make non-liquor sales prior to the issuance of your permit?: Yes No

13. If you operate as a corporation or partnership, list appropriate names, addresses and social security numbers below.:

     President/Partner Name & Address:

     President/Partner Social Security Nbr: enter as 999-99-9999

     Vice President/Partner Name & Address:

     Vice President/Partner Social Security Nbr: enter as 999-99-9999

     Treasurer/Partner Name & Address:

     Treasurer/Partner Social Security Nbr: enter as 999-99-9999

     Secretary/Partner Name & Address:

     Secretary/Partner Social Security Nbr: enter as 999-99-9999

If you need additional help contact the Auditors Office at 937-225-4314
Location: 451 W. Third St. PO BOX 972 Dayton,OH 45422-1031