SIC

code

4. Name of payee (Individual or business to be paid)

5. Mailing address where you want to receive payments

6. (Optional)

7. (Optional)

8. (Optional)

9. City State ZIP code

10.

Payee telephone number (Area code and number)

Security type code ( 0, 1, 2 )

Zone code

2. Texas Identification Number (TIN) - Indicate the type of number you are providing to be used for your TIN

Social Security number (SSN) (9 digits)

Individual Taxpayer Identification Number (ITIN) (9 digits)

Enter the number indicated

If "YES," enter Texas Taxpayer Number

Employer Identification Number (EIN) (9 digits)

1. Is this a new account? YES Mail Code 000 NO Enter Mail Code Agency number Complete Sections 1 - 5 Complete Sections 1, 2 & 5

For Comptroller's use only

11.

T - Texas Corporation:

If checked, enter the

Owner's name Texas File Number

SSN / ITIN (9 digits) - Professional Association:

If checked, enter the Texas

A

File Number

C - Professional Corporation:

If checked, enter the Texas File Number

Name

SSN / ITIN / EIN (9 digits)

Name

SSN / ITIN / EIN (9 digits)

I - Individual Recipient (not owning a business)

P - Partnership: If checked, enter two partner's names and

O - Out-of-State Corporation

G - Governmental Entity

U - State agency / University

F - Financial Institution

R - Foreign (out of U.S.A.)

N - Other: If checked, explain.

L - Texas Limited Partnership:

If checked, enter the

Texas File Number

Assignee name

Assignee TIN Assignment date

13. Comments Date

14.

Agency name Prepared by Phone (Area code and number)

15.

12. Payment Assignment? YES NO

AP-152

(Rev.7-25/19)

Application for Texas Identification Number

• See instructions on back

Se ct io n

Se ct io n

Payee Information (Please type or print)

Se ct io n

Ownership Codes - Check only one code by the appropriate ownership type that applies to you or your business.

Se ct io n 4 Note: A copy of the assignment agreement between payees must be attached.

Se ct io n

Authorized signature (Applicant or authorized agent)

Form AP-152 (Back)(Rev.7-25/19)

Application for Texas Identification Number Instructions

to bill agencies of the state government for goods, services provided, refunds, public assistance, etc. When the application is processed by the

the completed application to the state agency with which the applicant is conducting business.

application or with processing the form.

Specific Instructions Item 1: Is this a new account?

Select YES if the applicant has never received a payment from a Texas state agency and does not have an assigned TIN.

Select NO if the applicant has received payments from a Texas state agency and already has an assigned TIN.

Mail Code / Agency number – Will be entered by the state agency that processes the application.

agency that needs to pay a foreign entity or a foreign individual who does not have an EIN, SSN or ITIN.

Current Texas Identification Number (FOR STATE AGENCY USE ONLY): The 11-digit current Comptroller-assigned TIN.

and begin the address in Item 6.

Item 9: Enter the city, state and ZIP code.

Item 10: Enter the payee telephone number.

SIC code / Security type code / Zone code – These fields will be completed by the state agency that will process the application.

Section 4 — Payment Assignment Item 12: Select YES if the payee is assigning its payments to a third party and the state agency that will process the application has ap-

attached.

Select NO if the payee is not assigning its payments to a third party.

date signed.

Item 15: Agency name, Prepared by, Phone: Will be entered by the state agency that will process the application.

Under Ch. 559, Government Code, you are entitled to review, request and correct information we have on file about you, with limited exceptions in accordance with Ch. 552, Government Code. To request information for review or to request error correction, contact us at the address or phone numbers listed on this form.

https://fmx.cpa.texas.gov/fm/pubs/payment/ mailto: tins.mail@cpa.texas.gov