Florida Florida Business Tax Application

Florida Business Tax Application
DR-1 R. 01-22 TC 7-23 Fillable.pdf
Florida Business Tax Application
Register online at
floridarevenue.com/taxes/registration.
It's fast and secure.

DR-1
R. 01/22
TC 07/23
Rule 12A-1.097, F.A.C.
Effective 01/22
Page 1 of 15

ALL information provided as a part of this application is held confidential by the Florida Department of Revenue. Social security
numbers are used by the Florida Department of Revenue as unique identifiers for the administration of Florida's taxes. Social security
numbers obtained for tax administration purposes are confidential under sections 213.053 and 119.071, Florida Statutes, and not
subject to disclosure as public records. Collection of your social security number is authorized under state and federal law. Visit the
Department's website at floridarevenue.com/privacy for more information regarding the state and federal law governing the
collection, use, or release of social security numbers, including authorized exceptions.

Use Black or Blue Ink to Complete This Application

Business Information
All Applicants Identification Numbers

1 . Identification Numbers:
Federal Employer Identification Number (FEIN):
You must provide your FEIN before you can register for Reemployment Tax. If you are not required by the
Internal Revenue Service to obtain an FEIN, you must provide your social security number, unless you are not a
citizen of the United States.
Social Security Number (SSN):
If you are not a citizen of the United States and you do not have a social security number, provide your complete Visa
number.
Visa Number:
Florida Business Partner Number (if registered):
(business partner numbers are 4 to 7 digits in length)
Consolidated Sales and Use Tax Filing Number:
(if you file a consolidated sales and use tax return)
County Control Number:
(if you use this number to report tax for the county where your business is located)
2. Reason for Applying (select only one):
Business entity not currently registered
Date of first Florida taxable activity:

All Applicants Reason for Applying

mm dd yyyy
Additional Florida location for
currently registered business
Date of first taxable activity
mm dd yyyy

Sales and use tax for this location will be reported using my current:
(select all that apply)
consolidated return
county control reporting number

Additional Florida rental property for
currently registered business
Date of first taxable activity:
mm dd yyyy

Sales and use tax for this location will be reported using my current:
(select all that apply)
consolidated return
county control reporting number

Moved registered Florida location to
another Florida county Effective date:
mm dd yyyy

Current sales and use tax certificate number for location
(this number will be cancelled)
Sales and use tax for this location will be reported using my current
(select all that apply)
consolidated return
county control reporting number

DR-1
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Starting a new taxable activity at a
registered location Effective date:
mm dd yyyy
Change the form of business
ownership - Effective date:
mm dd yyyy

Current sales and use tax certificate number for location

Acquired existing business Effective date:

All Applicants Reason for Applying

mm dd yyyy
3. Business Name, Location, and Mailing Address:
Others - Use name filed with the Florida Department of State or
Sole proprietors - Use last name, first name, middle initial similar agency in another state
Partnerships - Use partnership name or last name of
general partners
Legal name of business:
Business trade name "doing business as" if you have one:

Physical Address: Provide the street address of the business location or Florida rental property - Do not use PO Box or
Rural Route Numbers.
Florida County:
Check if # is outside U.S.
Street address:
Telephone #:
#:

City / State / ZIP:

ext:

Fax #:
Mailing Address: Provide the name and mailing address where tax returns and other correspondence for your business
are to be mailed.
Mailing Address (if different than business location address):
Mail to:

All Applicants - Business Ownership

Seasonal
Business

City / State / ZIP:

4. Is this business location only open during a portion of a calendar year?
If yes, provide the:
First calendar month this business location is open:
; and the
Last calendar month this business location is open:

Yes

No

.

5. Form of Business Ownership: (select only one form of ownership)
Sole Proprietor (individual owner)
Limited liability company (LLC)
Partnership (select one below):
(select one below):
Married couple
Single member
General partnership
Multi-member
Limited liability partnership (LLP)
If single member,select the box that
Limited partnership (LP)
applies to how your LLC is treated for
Joint venture
federal income tax.
Corporation (select one below):
C Corporation
C Corporation
S Corporation
S Corporation
Disregarded (reported by single member)
Not-for-profit
If multi-member, select the box that applies
Foreign corporation
to how your LLC is treated for federal
income tax.
Partnership
C Corporation
S Corporation

Estate
Trust
Business
Other
Governmental agency

DR-1
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6. If your business is a partnership, corporation, limited liability company, or trust, provide the following information:
Date of Florida incorporation or organization,
or date of authorization to conduct business at this location in Florida:
mm dd yyyy
Fiscal year ending date (This date is generally "12/31"; however
a business may elect a different fiscal year):
7. If you are a sole proprietor, provide the following information:
Sole
Proprietors

Legal Name (first name, middle initial, last name):

mm dd
SSN:
or Visa #:

Home address:
Telephone #:
City / State / ZIP:

#:

Check if # is outside U.S.
ext:

8. If your business is a partnership (including married couples), provide the following information for each general partner:
(Attach additional pages, if needed.)
Name:
Title:
Home address:

SSN:

Business Owners and Managers

or Visa #:
or FEIN:
City / State / ZIP:

Telephone #:
#:

Name:

Title:

Home address:

SSN:

Check if # is outside U.S.
ext:

or Visa #:
or FEIN:
City / State / ZIP:

Telephone #:
#:

Name:

Title:

Home address:

SSN:

Check if # is outside U.S.
ext:

or Visa #:
or FEIN:
City / State / ZIP:

Telephone #:
#:

Name:

Title:

Home address:

SSN:

Check if # is outside U.S.
ext:

or Visa #:
or FEIN:
City / State / ZIP:

Telephone #:
#:

Check if # is outside U.S.
ext:

DR-1
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Page 4 of 15

9. If your business is a corporation, limited liability company, or trust, provide the following information for each director, officer, managing
member, grantor, personal representative, or trustee of the business entity:
(Attach additional pages, if needed.)
Title:
Name:
Home address:

Last 4 Digits of Social Security Number:

or Visa #:
or FEIN:
Telephone #:

City / State / ZIP:

Check if # is outside U.S.
ext:

#:
Title:

Business Owners and Managers

Name:
Home address:

Last 4 Digits of Social Security Number:

or Visa #:
or FEIN:
Telephone #:

City / State / ZIP:

Check if # is outside U.S.
ext:

#:
Name:

Title:

Home address:

Last 4 Digits of Social Security Number:

or Visa #:
or FEIN:
Telephone #:

City / State / ZIP:

#:
Name:

Check if # is outside U.S.
ext:

Title:

Home address:

Last 4 Digits of Social Security Number:

or Visa #:
or FEIN:
Telephone #:

City / State / ZIP:

All Applicants Business Activities

Applicants Background

#:
10. Background:
Has your business ever been known
by another name?

Yes

No

Name:

Was that business issued a Florida certificate
of registration or tax account number?

Yes

No

Number:

11. Business Activities:
Enter the six-digit North American Industry Classification
System (NAICS) code(s) that best describes your
business activities at this location. Enter your primary
code first. (Enter at least one.)

Primary code

If you do not know your NAICS code(s), go to census.gov/naics. Enter a keyword to
search the most recent NAICS list.

Check if # is outside U.S.
ext:

All Applicants Business Activities

DR-1
R. 01/22
Page 5 of 15

Describe the primary nature of your business and type(s) of products or services to be sold.

Business Changes and Acquisitions

12. Change in Form of Business Ownership or Acquired Business
If your form of business ownership has changed (e.g., sole proprietorship to a corporation or partnership to a limited liability
company), or you acquired an existing business, provide the following for your prior form of ownership or for the
acquired business:
Name:

FEIN:

Address:

Florida certificate or tax account number:

City / State / ZIP:

If acquired, portion acquired:
All

Part

Unknown

Did your business share any common ownership, management, or
control with the acquired business at the time of acquisition?
Yes
No

Did the previous legal entity or acquired business have employees
at the time of the change or acquisition?
Yes
No

Were employees transferred to the new legal entity or new
business?
Yes
No

Date transferred:

mm dd yyyy

You must also submit a completed Report to Determine Succession and Application for Transfer of Experience Rating Records
(Form RTS-1S) within 90 days after the date of transfer when:

You acquired an existing business in whole or in part, and

There was no common ownership, management or control between your business and the acquired business at the time of transfer.

Sales and Use Tax

Sales and Use Tax

13. For each of the business activities below, select all that apply to this location:
Sales, Rentals, or Repairs of Products
Sell products at retail (to consumers)
Sell products at wholesale (to registered dealers who will sell to consumers)
Sell products or goods from nonpermanent locations (such as flea markets or craft shows)
Sell products or goods by mail using catalogs or the internet
Sell, serve, or prepare food products or drinks for immediate consumption on your premises, or that you package or
wrap for take-out or to go, from a temporary or permanent location
Repair or alter consumer products or equipment
Rent equipment or other property or goods to individuals or businesses
Charge admissions or membership fees
Property Rentals, Leases, or Licenses
Rent or lease commercial real property to individuals or businesses
Manage commercial real property for individuals or businesses
Rent or lease living or sleeping accommodations to others for periods of six months or less
Manage the rental or leasing of living or sleeping accommodations belonging to others
Rent or lease parking or storage spaces for motor vehicles in parking lots or garages
Rent or lease docking or storage spaces for boats in boat docks or marinas
Rent or lease tie-down or storage spaces for aircraft at airports

DR-1
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Page 6 of 15

Sales and Use Tax (continued)
Real Property Contractors
Improve real property as a contractor
Sell products at retail (to consumers)
Construct, assemble, or fabricate building components at your plant or shop away from a project site that are used in
your real property improvement projects
Purchase products or supplies from vendors located outside Florida for use in Florida real property improvement
projects
Services
Pest control services for nonresidential buildings
Interior cleaning services for nonresidential buildings
Detective services
Protection services
Security alarm system monitoring services

Sales and Use Tax

Fuel
Sell tax paid gasoline, diesel fuel, or aviation fuel to retail dealers or end users in Florida (select all that apply below):
Gas station only
Gas station and convenience store
Truck stop
Marine fueling
Aircraft fueling
Reseller of fuel in bulk quantities
Purchase dyed diesel fuel for off-road purposes
Secondhand Goods or Scrap Metal
Purchase, consign, trade, or sell secondhand goods
Purchase, gather, obtain, or sell salvage or scrap metal to be recycled or convert ferrous or nonferrous metals into raw
material products
If you select either of these activities, you must also submit a Registration Application for Secondhand
Dealers and Secondary Metals Recyclers (Form DR-1S).
Coin-Operated Amusement Machines
Place and operate coin-operated amusement machines at locations belonging to others
Operate coin-operated amusement machines at this location (select all that apply below):
Self-operate some or all the amusement machines at this location (no other machine operator used)
Have entered into a written agreement with the following person or business to operate some or all the
machines at this location.
Name:

Telephone #:
#:

Check if # is outside U.S.
ext:

Mailing address:
City / State / ZIP:
If you operate amusement machines at your location or at locations belonging to others, you must also submit an Application for
Amusement Machine Certificate (Form DR-18) to obtain an annual Amusement Machine Certificate for each location where you
operate amusement machines.
Vending Machines
(select all that apply below)
Place and operate vending machines at locations belonging to others:
(Select the type or types of vending machines you operate.)
Food or beverage vending machines
Nonfood or nonbeverage vending machines
Operate vending machines at this location:
(Select the type or types of vending machines you operate.)
Food or beverage vending machines
Nonfood or nonbeverage vending machines

DR-1
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Sales and Use Tax

Sales and Use Tax (continued)

Purchases
Purchase items to use in my business without paying Florida sales tax to the seller at the time of purchase (such
as from a seller located outside Florida)
Applying for a direct pay permit to self-accrue and remit use tax directly to the Department
To apply for a permit, submit an Application for Self-Accrual Authority/Direct Pay Permit Sales and Use Tax
(Form DR-16A).
Applying for authority to remit sales tax to the Department for independent sellers or distributors (see Rule
12A-1.0911, Florida Administrative Code, for more information)
This business does not conduct activities at this location subject to Florida sales and use tax

Prepaid
Wireless Fee

Prepaid Wireless Fee
14. Do you sell prepaid phones, phone cards, or calling arrangements at this location?

Yes

No

If yes, select the box that describes your sales:
Domestic or international long distance calling or phone cards (non-wireless)
Prepaid wireless services (cards, plans, devices) that provide access to wireless networks and interaction with
911 emergency services

Solid Waste Fees
and Surcharge

Solid Waste - New Tire Fee, Lead-Acid Battery Fee, and Rental Car Surcharge
15. Do you sell (at retail) new tires for motorized vehicles at this location that are sold separately or as
part of a vehicle?

Yes

No

16. Do you sell (at retail) new or remanufactured lead-acid batteries at this location that are sold separately
or as a component part of another product such as new automobiles, golf carts, or boats?
Yes

No

17. Do you operate a car-sharing service, a peer-to-peer car sharing program, or motor vehicle rental
company at this location that provides motor vehicles that transport fewer than nine passengers?

Yes

No

Yes

No

Dry-Cleaning
Tax

Gross Receipts Tax on Dry-cleaning
18. Do you own or operate a dry-cleaning plant or dry drop-off facility in Florida?

If yes, and you import or produce perchloroethylene or other dry-cleaning solvents, you must also complete a
Registration Package (GT-400401) for fuels and pollutants.

Reemployment Tax

Reemployment Tax

For purposes of reemployment tax, employees include officers of a corporation and members of a limited liability
company classified as a corporation for federal tax purposes who perform services for the corporation or limited liability
company and receive payment for such services (salary or distributions).
In addition to registering for Reemployment Tax:

New Florida employers must register with the Florida New Hire Reporting Center to report newly hired and re-hired
employees in Florida at servicesforemployers.floridarevenue.com.

Florida employers are required to obtain appropriate workers' compensation insurance coverage for their employees.
Visit www.myfloridacfo.com/division/wc/.
19. Do you have or will you have, employees in Florida?

Yes

No

20. Do you, or will you, lease workers from an employee leasing company to work in Florida?
If yes, provide the following:

Yes

No

Name of leasing company:

Department of Business and Professional Regulation license number:

FEIN:

Date of leasing agreement for workers in Florida:

Portion of workforce that is leased:
All

Part

mm dd yyyy

DR-1
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Reemployment Tax (continued)
21. Do you use the services of persons in Florida whom you consider to be self-employed, independent contractors other
than those engaged in a distinct business, occupation, or profession that serves the general public (e.g., plumber,
general contractor, or certified public accountant)?

Yes

No

Yes

No

Are you currently reporting wages to the Florida Department of Revenue?

Yes

No

Are you reactivating your reemployment tax account?

Yes

No

If yes, you must also submit a completed Independent Contractor Analysis (Form RTS-6061).
If you answered No to questions 19, 20, and 21, proceed to the Communications Services Tax section.
If you answered Yes, continue to the next question.
22. Is your business registered for reemployment tax?
If yes, provide your RT account number:

23. On what date did you, or will you, first have an employee in Florida?
mm dd yyyy
24. Employment Type (select only one employment type):

Reemployment Tax

Regular employer
Nonprofit organization [must hold a
501(c)(3) determination letter from the
Internal Revenue Service]

Domestic employer [employer of
persons performing only domestic
(household) services (e.g., maid or
cook)]

Agricultural (noncitrus) employer
Agricultural (citrus) employer
Agricultural crew chief

Indian tribe or Tribal unit
Governmental entity
25. Select one category for your employment:
Regular, Indian tribe or Tribal unit, or Governmental employer
Have you or will you pay gross wages of at least $1,500 within a calendar quarter?

Yes

No

Yes

No

Yes

No

Yes

No

If yes, provide the date you reached or will reach $1,500 gross wages.
mm dd yyyy
Have you or will you have one or more employees for a day (or portion of a day) during 20 or more
weeks in a calendar year?
If yes, provide the last day of the 20th week.

mm dd yyyy

Nonprofit organization
Have you or will you employ four or more workers for a day (or portion of a day) during 20 or more
weeks in a calendar year?
If yes, provide the last day of the 20th week.

mm dd yyyy

Domestic employer (Employer whose employees only perform domestic services.)
Have you or will you pay gross wages of at least $1,000 within a calendar quarter?
If yes, provide the date you reached or will reach $1,000 gross wages.

mm dd yyyy

DR-1
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Reemployment Tax (continued)
Agricultural (noncitrus, citrus, or crew chief) employer
Have you or will you pay gross wages of at least $10,000 within a calendar quarter?

Yes

No

If yes, provide the date you reached or will reach $10,000 gross wages.
mm dd yyyy
Have you or will you have five or more employees for a day (or portion of a day) during 20 or more
weeks in a calendar year?

Yes

No

If yes, provide the last day of the 20th week.
mm dd yyyy
26. List all Florida locations where you have employees.
(Attach a separate sheet, if needed.)
Address:

Number of employees:

City / State / ZIP:

Principal products or services:

If services, indicate if:
Administrative

Research

Other

Reemployment Tax

Address:
Number of employees:

City / State / ZIP:

Principal products or services:

If services, indicate if:
Administrative

Research

Other

Address:

Number of employees:

City / State / ZIP:

Principal products or services:

If services, indicate if:
Administrative

Research

Other

Address:

Number of employees:

City / State / ZIP:

Principal products or services:

If services, indicate if:
Administrative

Research

Other

27. Payroll Agent Information. If you will use a payroll agent (such as an accountant or bookkeeper) or firm that will maintain your payroll
information, provide the following:
Name of payroll agent or firm:

Mailing address:

City / State / ZIP:

DR-1
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Page 10 of 15

Reemployment Tax (continued)

28. Mailing Addresses for Reemployment Tax. To receive correspondence about reemployment tax reporting, tax rates, and benefits
paid, select the appropriate mailing address for each type of correspondence below.
Reporting Forms and Information
Employer's Quarterly Reports, Certifications,
Reporting-related Correspondence:

Tax Rate Information
Tax Rate Notices
Related Correspondence:

Benefits Paid Information
Notice of Benefits Paid
Related Correspondence:

Business Information (address in the
the first section of this application)

Business Information (address
in the first section of this application)

Business Information (address in the
first section of this application)

Payroll Agent Information (address
in Question 27)

Payroll Agent Information
(address in Question 27)

Payroll Agent Information (address
in Question 27)

Other (enter below)

Other (enter below)

Other (enter below)

Other Address for Reporting Forms and Information

Reemployment Tax

Name:

Telephone #:

Ext:

Mailing address:

City / State / ZIP:

Email address:

Other Address for Tax Rate Information
Name:

Ext:

Telephone #:

Mailing address:

City / State / ZIP:

Email address:

Other Address for Benefits Paid Information
Name:

Ext:

Telephone #:

Mailing address:

City / State / ZIP:

Email address:

Communications Services Tax
Communications Services Tax

29. Do you sell communications services; purchase communications services to integrate into prepaid calling arrangements;
or are you applying for a direct pay permit for communications services tax?

Yes

No

If yes, select each service you sell.
Telephone service (e.g., local, long distance, wireless, or VOIP)

Video service (e.g., television programming or streaming)

Paging service

Direct-to-home satellite service

Facsimile (fax) service (not when providing advertising or

Pay telephone service

professional services)

Purchase services to integrate into prepaid calling arrangements

Reseller (only sales for resale; no sales to retail customers)
Other services; please describe:
30. Are you applying for a direct pay permit for communications services tax?
If yes, you must also submit an Application for Self-Accrual Authority/Direct Pay Permit (Form DR-700030).

Yes

No

DR-1
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Communications Services Tax (continued)
If you answered No to questions 29 and 30, proceed to the Documentary Stamp Tax section.
If you answered Yes, continue.
If you are a reseller only, sell only pay telephone or direct-to-home satellite services, or
only purchase services to integrate into prepaid calling arrangements, go to question 34.
31. To charge the correct amount of tax, you must know the taxing jurisdiction (county and municipality) in which your customers
are located. How will you verify the assignment of customer location to the correct taxing jurisdictions? If you use multiple
methods, select all that apply.
An electronic database provided by the Department of Revenue
Your own database that will be certified by the Department of Revenue
To apply for certification, you must submit an Application for Certification of Communications Services
Database (Form DR-700012).
Communications Services Tax

A database supplied by a vendor. Provide the name of the vendor and product:
Vendor:

Product:

ZIP + 4 and a methodology for assignment when the ZIP codes overlap jurisdictions
ZIP + 4 that does not overlap jurisdictions (e.g., a hotel located in one jurisdiction)
None of the above.
The method you use to verify the assignment of a customer location to the correct taxing jurisdictions (county and municipality) for purposes
of collecting local communications services tax determines the collection allowance rate that will be assigned to your business. If you change
your method of assigning a customer's location to the correct taxing jurisdictions, you must submit a Notification of Method Employed to
Determine Taxing Jurisdiction (Form DR-700020) indicating the new method(s). For more information, visit floridarevenue.com/taxes/cst.
32. If you use multiple assignment methods, you may need to file two separate returns to maximize your collection allowances. If you will file
separate returns for each assignment method, check the box below.
I will file two separate communications services tax returns, one for each type of assignment method.
33. Name and contact information of the person who can answer questions about communications services tax returns filed with the Department:
Name:

Telephone #:

Ext:

Email address:

Documentary
Stamp Tax

Documentary Stamp Tax
34.

Do you enter into written obligations to pay money with customers at this location that are not recorded with the
Clerk of the Court or County Comptroller (e.g., financing agreements, title loans, pay-day loans, liens, promissory
notes, or similar documents)?

Yes

No

If yes, do you anticipate executing five or more written obligations to pay money subject to documentary
stamp tax per month?

Yes

No

Yes

No

Yes

No

Gross Receipts Tax on Electrical Power and Gas
Gross Receipts
Tax

35.

Do you own or operate an electric or natural or manufactured gas (LP gas is excluded) utility distribution
facility in Florida?
If yes, select the type of utility facility:
Electric
Natural or manufactured gas

36.

Do you import natural or manufactured gas (LP gas is excluded) into Florida for your own use?

DR-1
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Severance Taxes

Severance Taxes and Miami-Dade County Lake Belt Fees
37. Do you extract oil, gas, sulfur, solid minerals, phosphate rock, lime rock, sand, or heavy minerals from the
soils or waters of Florida?

Yes

No

If yes, select each extraction activity that you will engage in:
Extracting oil for sale, transport, storage, profit, or commercial use
Extracting gas for sale, transport, profit, or commercial use
Extracting sulfur for sale, transport, storage, profit, or commercial use
Extracting solid minerals, phosphate rock, or heavy minerals from the soil or water for commercial use
Extracting lime rock or sand from within the Miami-Dade County Lake Belt Area (see section 373.4149, Florida Statutes, for
boundary description)

Enrollment to File and Pay Tax Electronically
Filing and paying electronically is quick, easy, and secure at floridarevenue.com/taxes/eservices. You can electronically file and pay most
taxes, fees and surcharges.
Marketplace providers and persons making a substantial number of remote sales (total of taxable remote sales in the previous calendar year
exceeds $100,000) must file and remit tax electronically.
You may choose to enroll to file or pay tax electronically. Enrolling allows you to view your payment history, reprint your payment information,
and view bills posted to your account. Your bank account and contact information are saved for future transactions.
If you enroll using this application, you will receive a user ID and password for each tax account created based on the information you
provide. Each account will have the same contact, banking, and payment method. After you receive your user ID and password, you may log
into each tax account and change the contact, banking, and method of payment information.

File and Pay Electronically

If you choose not to file returns or pay tax electronically, proceed to the
Authorization for Email Communication section.
38. Do you wish to: (select only one)
Enroll for both filing returns and paying tax electronically?
Enroll only to pay tax electronically?
File returns and pay tax electronically without enrolling?
39. If you are enrolling, select only one electronic payment method.
ACH-Debit (e-check) – The Department's bank withdraws a payment from your bank account when you authorize the payment.
ACH-Credit – Your bank transfers a payment to the Department's bank account when you authorize the bank to make the
payment. This is not a credit card payment. You are responsible for any costs charged by your bank to use this payment
method.
40. Contact Person for Electronic Payments:
Name:

Telephone #:

Ext:

Fax #:

Mailing address:

City / State / ZIP:

A company employee
Payroll agent

Email address:

A non-related tax preparer

Federal Preparer Tax Identification Number (PTIN):

DR-1
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Enrollment to File and Pay Tax Electronically (continued)
41. Contact Person for Electronic Return Filing (If different than contact person for electronic payments.)
Name:

Telephone #:

Ext:

Fax #:

Mailing address:

City / State / ZIP:

A company employee
Payroll agent

Email address:

A non-related tax preparer

42. Banking Information (not required for ACH-Credit payment method):
Bank / financial institution name:

Bank account number:

Federal Preparer Tax Identification Number (PTIN):

Account type:

Business

Checking

Personal

Savings

Bank Routing Number:

File and Pay Electronically

|:

:|

Note: Due to federal security requirements, we cannot process international ACH transactions. If any funding for payments comes from
financial institutions located outside the US or its territories, please contact us to make other payment arrangements. If you are unsure, please
contact your financial institution.
43. Enrollee Authorization and Agreement:

This is an Agreement between the Florida Department of Revenue, hereinafter "the Department," and the business entity named herein,
hereinafter "the Enrollee," entered into according to the provisions of the Florida Statutes and the Florida Administrative Code.
By completing this agreement and submitting this enrollment request, the Enrollee applies and is hereby authorized by the Department
to file tax returns and reports, make tax and fee payments, and transmit remittances to the Department electronically. This agreement
represents the entire understanding of the parties in relation to the electronic filing of returns, reports, and remittances.
The same statute and rule sections that pertain to all paper documents filed or payments made by the Enrollee also govern an
electronic return, or payment initiated electronically according to this agreement.
I certify that I am authorized to sign on behalf of the business entity identified herein, and that all information provided in this section
has been personally reviewed by me and the facts stated in it are true. According to the payment method selected above, I hereby
authorize the Department to present debit entries into the bank account referenced above at the depository designated herein
(ACH-Debit), or I am authorized to register for the ACH-Credit payment privilege and accept all responsibility for the filing of payments
through the ACH-Credit method.
Printed name:

Signature: ___________________________________ Title:

Date:

Printed name:

Signature: ___________________________________ Title:
(If account requires two signatures)

Date:

DR-1
R. 01/22
Page 14 of 15

Authorization for Email Communication

Email Communication

Your privacy is important to the Department of Revenue. The Department will mail information regarding this application to you. If you wish to
receive the information in an email, a written request from you is required. This request allows the Department to send information using its
secure email software. This software requires additional steps before you can access the information.
Complete this section to receive information about this application by secure email.

I authorize the Department to send information regarding this Application using the Florida Department
of Revenue's secure email. I understand that this method requires additional steps to view the information provided.
Provide the name and contact information of the person who can respond to questions about this Application.
Name:

Telephone #:

Check if # is outside U.S.

#:

ext:

Email address:

Applicant Declaration and Signature

Applicant Declaration and Signature

I understand that any person who is required to collect, truthfully account for, and pay any tax, fee, or surcharge, and willfully fails to do so, or any
officer or director of a corporation who directs any employee of the corporation to do so, is personally liable for the tax, fee, or surcharge evaded,
not accounted for, or paid to the Florida Department of Revenue, plus a penalty equal to twice the amount of the tax, fee, or surcharge due that is
evaded, not accounted for, or paid. (Section 213.29, Florida Statutes.)
I understand that, in addition to any other civil penalties provided by law, it is a criminal offense to fail or refuse to collect a required tax, fee, or
surcharge; to fail to timely file a tax, fee, or surcharge return; to underreport a tax, fee, or surcharge liability on a return; or to give a worthless check,
draft, debit card order, or other order on a bank to transfer funds to the Florida Department of Revenue.
I understand that I must notify the Florida Department of Revenue of any change in the form of ownership of this business or a change in business
activities, location, mailing address, or contact information for this business.
I certify that I am authorized by _________________________________ (Officer/Director) to execute this application. I understand that I
will be creating a tax account that may result in the responsibility to file returns and to pay a tax, surtax, fee, or surcharge to the Florida
Department of Revenue.
Under penalties of perjury, I declare that I have read the foregoing Application and that the facts stated in it are true.
Printed name:

Title:

Signature:________________________________________________________ Date:

Before you submit your completed application
Have you:

Mail to: Account Management MS 1-5730

Provided your business identification numbers?

Florida Department of Revenue

Completed all sections of this application?

5050 W Tennessee St

Signed and dated this application?

Tallahassee FL 32399-0160





Included all additional applications, if required?



DR-1
R. 01/22
Page 15 of 15

Contact Us

You may also bring your completed application to your
nearest taxpayer service center. To find a taxpayer service
center near you, visit floridarevenue.com/taxes/servicecenters.
Information, forms, and tutorials are available on the Department's
website at floridarevenue.com.

To speak with a Department representative, call Taxpayer Services at
850-488-6800, Monday through Friday, excluding holidays.
Subscribe to Receive Updates by Email
Visit floridarevenue.com/dor/subscribe to sign up to receive an email
when the Department posts:
• Tax Information Publications (TIPs)

For written replies to tax questions, write to:
Taxpayer Services MS 3-2000
Florida Department of Revenue
5050 W Tennessee St
Tallahassee FL 32399-0112

• Proposed rules, including notices of rule development workshops
and emergency rulemaking
• Due date reminders for reemployment tax and sales and use tax

References
The following documents were mentioned in this form and are incorporated by reference in the rules indicated below.
The forms are available online at floridarevenue.com/forms.
Form RTS-1S

Report to Determine Succession and Application For Transfer of
Experience Rating Records

Rule 73B-10.037, F.A.C.

Form DR-1S

Registration Application for Secondhand Dealers and Secondary
Metals Recyclers

Rule 12A-17.005, F.A.C.

Form DR-18

Application for Amusement Machine Certificate

Rule 12A-1.097, F.A.C.

Form DR-16A

Application for Self-Accrual Authority/Direct Pay Permit Sales
and Use Tax

Rule 12A-1.097, F.A.C.

GT-400401

Registration Package for Motor Fuel and/or Pollutants,
includes the following forms:

Form DR-156

Florida Fuel or Pollutants Tax Application

Rule 12B-5.150, F.A.C.

Form DR-600

Enrollment and Authorization for e-Services

Rule 12-24.011, F.A.C.

Form DR-157W

Bond Worksheet Instructions

Rule 12B-5.150, F.A.C.

Form DR-157

Fuel or Pollutants Tax Surety Bond

Rule 12B-5.150, F.A.C.

Form DR-157A

Assignment of Time Deposit

Rule 12B-5.150, F.A.C.

Form DR-157B

Fuel or Pollutants Tax Cash Bond

Rule 12B-5.150, F.A.C.

Form RTS-6061

Independent Contractor Analysis

Rule 73B-10.037, F.A.C.

Form DR-700030

Application for Self-Accrual Authority/Direct Pay Permit

Rule 12A-19.100, F.A.C.

Form DR-700012

Application for Certification of Communications Services Database Rule 12A-19.100, F.A.C.

Form DR-700020

Notification of Method Employed to Determine Taxing Jurisdiction Rule 12A-19.100, F.A.C.