Telephone Tax Information Form
BUSINESS INFORMATION
Company UBI#
Address Fed Tax ID#
City, State, Zip Code
Authorized Contact Phone
Email Fax
Phone Services Provided (check all that apply)
Traditional Telephone Other (please list)
Cellular
Internet/VOIP
Paging
2015 revenue generated in the City of Spokane Valley from telephone services $
Correspondence and questions regarding return and remittance should be addressed to:
Name Phone
Address
The undersigned swears or affirms under penalty or perjury that the information herein is full and true and that he/she knows
the same to be so.
This information was sent to the incorrect address and
has been forwarded to _________________________
at the following address: Signature
Name (typed or printed)
Date
TELEPHONE UTILITY TAX
INFORMATION FORM