Ets Form 001 7/02/03 - Sales/use Tax License Application Form 2003
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1Department Use Only
Sales/Use Tax License Application
SIC___________RID______________
Wyoming Department of Revenue
122 West 25th Street
License #_______________________
Cheyenne, WY 82002-0110
Filing Freq:_____________________
Voluntary Agreement Type:________
Nexus:_________________________
1. Date this applicant started business in Wyoming?
2. Business Name or DBA:
3. Mailing Address:
Street or Box No.
City
State
Zip Code
4. Location Address:
Street
City
State
Zip Code
5. Is this business located within the boundaries of an incorporated city or town in Wyoming?
Yes
No
6. Does this company have a physical location in this state?
Yes
No
7. Does your company make deliveries of tangible personal property into this state with your own vehicles?
Yes
No
8. Do you have employees, sales representatives, or other agents working temporarily or permanently in the State
of Wyoming?
Yes
No
9. Internet E-mail Address________________@___________________________________________________________
10. Business Telephone Number: (
)_____-___________ (800)______-___________Fax No.(
)______-____________
11. Authorized person to contact regarding sales/use tax matters ____________________________(
)____-____________
(Name)
(Phone Number)
12. Estimated monthly sales volume?
$_______________________
13. Describe specifically the type of products you sell, (Examples: auto parts, computers, vitamins) and/or services you
provide, (Examples: auto repair, computer repair) and the percent of the total sales each type represents [Example: (must
equal 100%) motel 50%, restaurant 30%, bar 20%]
(A)________________________
______%
(B)________________________
______%
(C)________________________
______%
(D)________________________
______%
14. What type of sales does this business make (check one) Wholesale_________Retail_________Both_________
15. Does this business have more than one location in Wyoming?
Yes
No
If Yes, how many?__________
16. Would you prefer to file a consolidated return for all locations? Yes
No
If yes provide a list of the
Wyoming Sales/Use Tax License numbers you would like to report on the consolidated return.
17. Do you provide lodging services?
Yes
No
18. Do you sell cigarettes, cigars, snuff, or other tobacco products?
Yes
No
19. Do you have a liquor license for use in this business?
Yes
No
If yes, please provide the following:
Liquor License Type
License Number
Name of License Owner
20. Do you sell propane, butane, liquefied gas, or compressed natural gas?
Yes
No
21. Do you extend or arrange for the extension of consumer credit?
Yes
No
22. Please check one of the following to best describe your ownership:
* (spousal ownership is considered a partnership)
(A)
Individual
(E)
Limited Partnership
(B)
Association/Club
(F)
Limited Liability Company
(C)
Partnership
(G)
Other (explain)
(D)
Corporation (1)______________________(2)_________________(3)____________________
(Corporate Name)
(federal identification number)
(date registered in Wyoming)
Note: Corporations, limited partnerships, and limited liability companies must provide evidence of registration with
the Wyoming Secretary of State's Office (307) 777-7311). Corporations must attach a complete list of officers .
Limited liability companies must attach a complete list of members or managers . Licensing will be delayed
until this information is provided.
23. Complete this section by printing the name and social security number for the following individuals: Individual
ownership: owner; Partnership: all partners; Corporations: one major officer; Limited liability company and limited
partnerships: one member or manager. Signatures must be original.
A.
Print Name:
Signature:
SSN:
Address:
City
State
Zip Code:
B.
Print Name:
Signature:
SSN:
Address:
City
State
Zip Code:
C.
Print Name:
Signature:
SSN:
Address:
City
State
Zip Code:
D.
Print Name:
Signature:
SSN:
Address:
City
State
Zip Code:
Don't Forget! Include the $60.00 non-refundable application fee. - Get all signatures required.
Complete this application in its entirety and attach all required documentation.
Incomplete applications will be returned and licensing delayed.
Call Taxpayer Services at (307) 777-5200 for assistance in completing application.
ETS Form 001 (Revised 7/02/03)
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