Fillable Rev-1176 e-TIDES Administrative Access Change Request Form (REV-1176)

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Rev-1176 e-TIDES Administrative Access Change Request Form (REV-1176)

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The Rev-1176 e-TIDES Administrative Access Change Request Form (REV-1176) form is 1 page long and contains:

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Country of origin: US
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REV-1176 (AS+) 06-18 (FI)
E-TIDES aDMInISTRaTIVE
accESS chanGE
REQuEST FoRM
BUREAU OF BUSINESS TRUST FUND TAXES
PO BOX 280908
HARRISBURG PA 17128-0908
Requesters Relationship to Business
Business Name
This document must be accompanied by the REV-677, Power of Attorney and Declaration of Representative form, or written authorization on com-
pany’s letterhead signed by both the owner and person requesting access.
CHECK ALL TAX TYPES THAT APPLY.
EIN
Business Name
Email Address Telephone Number
Individual Registered on e-TIDES User ID of Registered Individual
This form is used to reassign e-TIDES Administrative Access to another person or to request access as an additional e-TIDES filer. When
using this form for multiple tax types, each tax account must be registered under the requester’s User ID and Password and listed below
to have access granted. You must complete the registration steps below before submitting this form.
To REGISTER on e-TIDES
First-time e-TIDES users must register at www.etides.state.pa.us, creating a User ID and Password.
Step one
•
Select “Enter e-TIDES”.
•
Select “Register,” located at the bottom of the page.
•
Select “I Agree” to the e-Signature Agreement to create your User ID and Password.
Step Two
•
Select “Register Enterprise” from the left navigation.
•
Choose your tax type and select “Next”.
•
Select “I Agree” to the agreement.
•
Enter your account number, Entity ID and type of Entity ID, then select “Next”.
•
Select “Submit” to process your request to be added as a user on e-TIDES.
For additional information, please visit the department’s Online Customer Service Center at www.revenue.pa.gov or call the e-Business
Tax Unit at 717-783-6277.
Completed forms can be emailed to ra-btftebusiness@pa.gov Fax to: 717-787-0145
chanGE Tax accounT aDMInISTRaTIVE accESS
REQuESTER conTacT InFoRMaTIon
Signature
Title Date
SIGnaTuRE oF REGISTERED InDIVIDuaL anD TITLE
Tax TYPE accounT nuMBER Tax TYPE accounT nuMBER
THIS WILL REMOVE ACCESS FROM THE CURRENT ADMINISTRATOR FOR THIS TAX ACCOUNT
REQUESTING ACCESS AS AN ADDITIONAL e-TIDES FILER ONLY
Sales and Use Tax
Employer Withholding
Corporate Tax
Other Tax Type
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Rev-1176 e-TIDES Administrative Access Change Request Form (REV-1176)

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Completed 13 February 2020

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