Questionnaire Regarding Activities In Arizona Form - Arizona Department Of Revenue Page 3
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4Employee and Other Activity in Arizona
Yes
No
1. Has the Company had employees on the Company’s payroll, that normally perform .............................
services in a state other than Arizona, but occasionally or temporarily perform work
in Arizona?
2. Has the Company had any representatives within Arizona at any point in time? ....................................
(full time, part time, traveling, resident, nonresident, etc.) Check all that apply:
.
Date activities performed:
a. Commissioned agents ....................................................
from___/___/___ to ___/___/___
b. Independent sales representatives ................................
from___/___/___ to ___/___/___
c. Contractors .....................................................................
from___/___/___ to ___/___/___
d. Sub-Contractors .............................................................
from___/___/___ to ___/___/___
e. Manufacturers’ representatives ......................................
from___/___/___ to ___/___/___
f. Missionary agents / Traveling sales representatives ......
from___/___/___ to ___/___/___
If yes to either question above please give name, address, relationship to Company and duties performed on a separate sheet of paper.
While in Arizona, do any company employees or representatives, as listed above, perform any of the following:
Yes
No
3. Sell products? ..........................................................................................................................................
4. Sell service? .............................................................................................................................................
5. Provide samples for display, dispense or replacement? ..........................................................................
If yes, average value of samples: $____________
6. Supervise or manage activities of employees and/or other company representation? ............................
7. Perform, install or oversee installation of Company products? ................................................................
8. Retain the right to inspect or approve the installation of Company products? .........................................
9. Engage in any repair work? .....................................................................................................................
10. Engage in any collection activity of any kind? ..........................................................................................
11. Handle complaints of Arizona customers? ...............................................................................................
12. Inspect products or offer technical assistance about product’s use after sale or installation? .................
13. Conduct lectures or offer training? ...........................................................................................................
14. Investigate, recommend or appoint potential Arizona dealers, agents or distributors to Company? .......
15. Check inventories of customers, distributors, or their customers? ..........................................................
16. Replace obsolete, damaged, outdated or returned inventories for customers? ......................................
17. Use their Arizona homes as offi ces? ........................................................................................................
a. As a business address? .....................................................................................................................
b. To meet with business customers? ....................................................................................................
c. To store inventory? .............................................................................................................................
d. Are employees reimbursed for telephone, fax or utility expenses? ....................................................
e. Does the company directly pay any of the offi ce expenses? .............................................................
18. Does the company list an Arizona telephone number? ............................................................................
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ADOR 10894 (7/10)
Previous ADOR 20-1068
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