West Virginia Schedule DBA Registration of Additional Trade Names

Schedule DBA Registration of Additional Trade Names
Schedule DBA
SCHEDULE

DBA

WV BUS-APP

REGISTRATION OF ADDITIONAL
TRADE NAMES

Attach multiple copies of this form if needed. Trade names and DBAs not submitted on the BUS-APP, BUS-RBL, or this form, may not be properly added
to account.

SECTION A: REASON FOR SUBMITTING THIS APPLICATION
CHOOSE ONLY ONE:

SUBMITTED WITH
BUS-APP

SUBMITTED WITH
BUS-RBL

SENT
SEPARATELY

TOTAL NUMBER OF DBAs OR TRADE NAMES:

SECTION B: PRIMARY BUSINESS IDENTIFICATION
LEGAL BUSINESS NAME

FEIN (SSN For Sole Proprietor)

CONTACT

TITLE

CONTACT EMAIL

PHONE NUMBER

1

2

SECTION C: ADDITIONAL DBA OR TRADE NAMES
TRADE NAME

WV TAX ACCOUNT # (If associated with a specific WV tax account)

ADDRESS If this trade name is to be used at a specifc location, different than the Primary business, list here. If it applies to all locations of the business, write SAME. No PO Boxes
3

CITY

STATE

ZIP

TRADE NAME

WV TAX ACCOUNT # (If associated with a specific WV tax account)

ADDRESS If this trade name is to be used at a specifc location, different than the Primary business, list here. If it applies to all locations of the business, write SAME. No PO Boxes
4

CITY

STATE

ZIP

TRADE NAME

WV TAX ACCOUNT # (If associated with a specific WV tax account)

ADDRESS If this trade name is to be used at a specifc location, different than the Primary business, list here. If it applies to all locations of the business, write SAME. No PO Boxes
5

CITY

STATE

ZIP

TRADE NAME

WV TAX ACCOUNT # (If associated with a specific WV tax account)

ADDRESS If this trade name is to be used at a specifc location, different than the Primary business, list here. If it applies to all locations of the business, write SAME. No PO Boxes
6

CITY

STATE

ZIP

MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
TAX ACCOUNT ADMINISTRATION DIVISION
REGISTRATION & ACCOUNT CORRECTION UNIT
PO BOX 2666
CHARLESTON WV 25330-2666

*B29201905W*
B

2

9

2

0

1

9

0

5

W