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DATE DAYTIME TELEPHONE # SIGNATURE Please sign after printing
REV-1830 (AS) 01-18
BUSINESS NAME AND ADDRESS
LEGAL NAME
TRADE NAME
ADDRESS
CITY, STATE, ZIP
EMAIL ADDRESS
PLEASE READ THE INSTRUCTIONS BEFORE COMPLETING.
Please note that by filing this form it will not register you for a Pennsylvania Sales, Use and Hotel OccupancyTax license.
• Complete the applicable fields: PA Sales Tax Account and Entity ID (federal EIN/SSN), Legal Name, Trade Name,Address, City, State and Zip Code.
• Select:
o (Line 1.) Elect to: Register to collect and remit PA Sales Tax (or)
o (Line 2.) Elect to: Comply with the notice and reporting requirements
o (Line 3.) Enter - Total Taxable Sales in PA for the preceding year
• Complete the Date and Daytime Telephone # fields.
• Upon printing, please Sign the Election Form and submit the form to [email protected]
If you select Line 1, you must have a Pennsylvania Sales Tax License. If you need to register to obtain a sales tax license,please visit www.pa100.state.pa.us to fill out the PA-100 Pennsylvania Enterprise Registration Form.
If you select Line 2, and the business is opting to comply with the notice and reporting requirements, you are requiredto submit an electronic upload file. This electronic upload will include the sellers’/purchasers' names, addresses andamount of goods sold/purchased. Please visit the Marketplace Sales Guidance page for file upload specificationsand instructions.
Failure to comply with the selected option could result in a penalty assessment of up to $20,000 per violation per year,or 20% of sales in Pennsylvania, whichever is less.
To Complete the Annual Marketplace Sales Election Form:
The initial election made on or before March 1, 2018, shall be effective April 1, 2018 and for the balanceof the Pennsylvania Department of Revenue’s 2017-2018 and 2018-2019 fiscal years.
$
ENTITY ID (EIN)PA SALES TAX ACCOUNTELECTION YEAR END
DO NOT SEND PAYMENT WITH THIS FORM.
The initial election made on or before March 1, 2018, shall be effective April 1, 2018
and for the balance of the Pennsylvania Department of Revenue’s 2017-2018
and 2018-2019 fiscal years.
1.ELECT TO: REGISTER TO COLLECT & REMIT PA SALES TAX
2.ELECT TO: COMPLY WITH THE NOTICE & REPORTING REQUIREMENTS
3. TOTAL TAXABLE SALES IN PA
ANNUAL MARKETPLACESALES ELECTION FORM
Please select one of the following:
REV-1830 (AS) 01-18
ANNUAL MARKETPLACE SALES ELECTION FORM
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06/30/2019