Fillable Printable Business Contact Change Form, 150-211-159

Business Contact Change Form, 150-211-159

150-211-159 (Rev. 12-12)

Oregon Combined Payroll Tax

Business Contact Change Form

Business name BIN (Oregon business identification number)

Other names (ABN/DBA) FEIN (Federal employer identification number)

Update mailing address

(attach additional sheet if necessary)

Check all that apply: Billings

Business mail

Payroll tax forms

Address

City State Zip

Telephone

Extension

( )

Cell

Extension

( )

Fax

Extension

( )

E-mail

Check here to authorize us to initiate e-mail

exchange of tax information

Revoke all prior e-mail

addresses

Update physical locations

(attach additional sheet if necessary)

#1 Add location Delete location #2 Add location Delete location

Reason Reason

Street address Street address

City State Zip City State Zip

Is this an employee’s home address? Is this an employee’s home address?

Update offsite payroll services, accountants or bookkeepers

(attach a Power of Attorney for Authorized Representative)

Name of service, accountant or bookkeeper Effective date

Contact Telephone Extension

( )

Address

City State Zip

Fax

( )

E-mail

Submitted by:

Print name Title Telephone

( )

Signature Date

Fax to: 503-947-1700

Or mail to: Employment Department, 875 Union St NE Rm 107, Salem OR 97311-0030

To update contact and address information

Current information will ensure that you receive

tax forms and other important information.

Form available electronically at: https://secure.sos.state.or.us/ABNWeb

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