Sales Tax License Application Form - City And County Of Broomfield

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City and County of Broomfield, One DesCombes Drive, Broomfield CO 80020
Finance Department, Sales Tax Division
Sales Tax License Application
NO FEE REQUIRED
CART/KIOSK DEPOSIT $200.00
E-Mail:
Web:
303-464-5811 FAX 303-410-3802
Licenses will not be issued unless this form is filled out completely.
CART/KIOSK DEPOSIT MUST ACCOMPANY APPLICATION
Please allow up to two weeks for processing of application. Please Print
Business Information
Business
Name______________________________________________________________________________
DBA Name (if
different)________________________________________________________________________
Physical
Address_____________________________________________________________________________
City______________________________________State_______________________Zip___________________
_
Business Phone__(____)_____________________Business Fax__(____)_______________________________
Business Web Address________________________________Business E-
Mail___________________________
Mailing Information
Contact
Person______________________________________________________________________________
Mailing
Address______________________________________________________________________________
City______________________________________State_______________________Zip___________________
_
Owner/Officer Information
_________________________________________Phone
number/Address_______________________________
_________________________________________Phone
number/Address_______________________________
Type of Ownership Individual/Sole Proprietor_____ Partnership_____ LLC_____ Corporation_____ Trust_____
Type of Location
Commercial__________
Home Based_________
FEIN or Social Security Number____________________ State Sales Tax
Number______________________
Reporting Frequency Monthly________ Quarterly_________ Annually_________
Registered with the Secretary of State in Colorado
Yes_____
No_____

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