Business Mailing Address Change / Correction Form

An Official Pennsylvania Government Website

Department of Revenue

Required fields are marked with an asterisk.(*)

SECTION I - BUSINESS INFORMATION

Business Legal Name

*

Business Street Address - Line 1 (no PO BOX)

*

Business Street Address - Line 2 (no PO BOX)

*

City

*

State/Province

If not in the United States, Province/Territory

*

Postal Code

*

Country

International Calling Code

Business Telephone Number

*

Extension

*

Business Email

**

Confirm Business Email

**

Tax ID Number

*

Tax ID Type

PA Tax Account Number

*

SECTION II - MAILING ADDRESS UPDATES

Mailing Address - Line 1

*

Mailing Address - Line 2

*

City

*

State/Province

If not in the United States, Province/Territory

*

Postal Code

*

Country

SECTION III - VALIDATION (Must provide at least one of the following pieces of identifying information.)

Provide the PIN of the submitted online PA100

*

Provide the Revenue ID Number

*

Provide the last 4 digits of the social security number for the owner, officer or responsible party of the business

*

SECTION IV - PREPARER INFORMATION

First Name

*

Last Name

*

Title

*

Preparer Email

**

Confirm Preparer Email

**

Telephone Number (XXX-XXX-XXXX)

*

Extension

*

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