Application Form For Manufacturer/importer Tobacco Products License Page 2
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7BOE-400-LT (S2F) REV. 2 (1-11)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
SECTION II: OWNERSHIP INFORMATION
1. PLEASE CHECK TYPE OF OWNERSHIP
Married Co-Partnership
Sole Owner
Partnership
Limited Partnership (LP)
Limited Liability Partnership (LLP)
Limited Liability Company (LLC)
Corporation
Registered Domestic Partnership
Other (describe)
2. ENTER FULL CORPORATE, LIMITED LIABILITY COMPANY (LLC), OR ORGANIZATION NAME
3. FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)
4. CALIFORNIA CORPORATE OR LLC NUMBER/STATE OF INCORPORATION OR ORGANIZATION
SECTION III: BUSINESS INFORMATION
1. BUSINESS OR TRADE NAME (DBA if any)
1. BUSINESS OR TRADE NAME (DBA if any)
EMAIL ADDRESS
EMAIL ADDRESS
BUSINESS TELEPHONE NUMBER
BUSINESS TELEPHONE NUMBER
(
(
)
)
2. BUSINESS ADDRESS (do not list PO Box or mailing service)
2. BUSINESS ADDRESS (do not list PO Box or mailing service)
CITY
CITY
STATE
STATE
ZIP CODE
ZIP CODE
3. MAILING ADDRESS (if different from No. 2 above)
3. MAILING ADDRESS (if different from No. 2 above)
CITY
CITY
STATE
STATE
ZIP CODE
ZIP CODE
4. NAME OF BOOKKEEPER/ACCOUNTANT
ADDRESS
TELEPHONE NUMBER
(
)
5. NAME OF REGISTERED AGENT FOR RECEIPT OF SERVICE OF PROCESS IN THIS STATE ADDRESS
TELEPHONE NUMBER
(
)
6. NAMES OF CORPORATE BANKS, SAVINGS AND LOANS, CREDIT UNIONS
ADDRESS
ACCOUNT NUMBER TYPE OF ACCOUNT
ADDRESS
7. PARENT CORPORATION (DBA if any)
7. PARENT CORPORATION (DBA if any)
ADDRESS
8. OTHER ACCOUNT NUMBERS ISSUED TO YOU BY THE BOARD
9. BUSINESS RECORDS WILL BE MAINTAINED AT:
SECTION IV: REQUIREMENTS TO SUBMIT AND UPDATE SCHEDULE OF TOBACCO PRODUCTS BRAND FAMILY NAMES
Pursuant to Chapter 4 of the California Business and Professions Code (commencing with section 22979.21), in order to be
eligible for obtaining and maintaining a license, a manufacturer or importer must submit to the BOE a list of all tobacco product
brands that they manufacture or import.
Please complete and submit with your application and certification BOE-400-LT1, Schedule of Tobacco Products Brand Family
Names.
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