As/rp 1 - Sales And Use Tax And Income Tax Withholding Registration Application
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1
2Sales and Use Tax and Income Tax Withholding
AS/RP 1
Registration Application
North Carolina Department of Revenue
Rev. 4-99
I. Identifying Information
1. Type of Ownership:
Proprietorship
Fiduciary
Partnership
LLC
LLP
Other (Identify)
S Corp. State of Inc.
C Corp.
If N.C. Corporation or LLC, enter N.C. Secretary of State ID No.
2. Legal Business/Owner’s Name
4. Daytime Business Phone
3. Trade Name/DBA Name
5. Federal Employer ID No.
6. Proprietor’s Social Security No.
7. List primary partners or corporate officers (President, Vice President, Secretary, Treasurer)
SOCIAL SECURITY NO.
ADDRESS
NAME
TITLE
8. Business Location in N.C.
Street
County
(Not P.O. Box Number)
City
State
Zip Code
9. Is the business located within city or town limits?
10. Number of locations in N.C.
Enclose list if more than one.
Yes
No
11. Mailing Address
Street or P.O. Box
State
City
Zip Code
II. Withholding Tax Section
- Complete this section if you are applying for an Income Tax Withholding Number. No fee is required.
Do you have employees who are subject to N.C. withholding?
Yes
No
Date on which wages were or will first be paid in N.C.
Do you pay compensation (other than wages to employees) to a nonresident entity or a nonresident individual for personal services
performed in N.C.?
Yes
No
If yes, do you choose to report this withholding separately? (See instructions.)
Yes
No
Amount of tax you expect to withhold each month:
less than $500 (Quarterly)
$500 - $2,000 (Monthly)
more than $2,000 (Semi-weekly)
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
If you operate a seasonal business, check months employees are paid:
III. Sales and Use Tax Section -
Complete this section if you are applying for a Sales and Use Tax Number. If you will be making
retail or wholesale sales, enclose payment in the amount of $15.00.
When will you start selling or purchasing items subject to N.C. sales or use tax?
(You will be required to file returns beginning with the month or quarter you indicate.)
What accounting method will you use?
Cash
Accrual
Will your sales be?
Retail (to users or consumers)
Wholesale (to registered merchants for resale)
Both Retail and Wholesale
What will you be selling? (Be specific.)
Yes
No
Will you sell electricity or telecommunications services?
Will you sell new tires?
Yes
No
Will you lease motor vehicles to others?
Will you sell new appliances?
Yes
No
Yes
No
Fee $15.00
Yes
No
ENTER AMOUNT PAID
Will you have a place of business in Mecklenburg County?
$
If you are a nonresident seller, will you have sales persons operating in Mecklenburg County?
Yes
No
.
Are you registering only to remit use tax on your purchases?
Yes
No
If yes, no fee is required.
Amount of sales tax expected each month:
less than $100 (Quarterly)
$100 - $20,000 (Monthly)
$20,000 or more (Semimonthly)
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
If you operate a seasonal business, check months of sales:
IV. Signature
Title
Date
I
certify that, to the best of my knowledge, this application is accurate and complete.
Attach payment for amount due and mail to: P. O. Box 25000, Raleigh, NC 27640-0100
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