Department of Labor Enrollment form
Fee: $40.00 *mandatory
Applicant Information*
First Name*
Last Name*
What is your Title in the business?*
Date of birth*
SSN*
Band details
account number
routing number
bank name
E-mail*
Business Phone Number*
Business Type* ---Sole ProprietorshipPartnershipLimited PartnershipCorporationLimited Liability Company (LLC)Nonprofit OrganizationCooperative
Are there other individuals who should be listed on the business registration certificate?* YesNo
Full Business Name*
DBA (Doing Business As)
Reason for Application* ---Started a New BusinessHired EmployeesBanking or Financial PurposesChanged Business TypePurchased an Active BusinessOther Reason
Business Start Date*
First payroll date*
Number of emploees*
Annual income of the company*
Annual Tax amount *
Do you accept or intend to accept cards? * ---YesNo
Please select your Business Field * ---AccountingBeauty and Skin CareConsultingEducationEntrepreneurship / Small BusinessFinanceHuman ResourcesLeadership Development ProgramsMarketingNonprofitReal EstateRetailSalesServicesOther
Please describe what you are selling or promoting. *
Business Address*
Street Address*
Address Line 2*
City*
State / Province / Region*
Postal / Zip Code*
Country* ---USARussia
Is the Business Address the same as the mailing address? YesNo
Address Line*
Approval and Payment By clicking 'Submit' below, you will be transferred to the payment page. Your payment will only be processed if your application is approved.
Do you understand that your application will not be processed if your payment is not submitted immediately?* Has all of the information provided been accurate to best of your knowledge?*
Business hours from 9 am to 9 pm, SUN through SAT