Sales/use Tax License Application Form - Wyoming Department Of Revenue
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1Sales/Use Tax License Application
DEPARTMENT USE ONLY
Wyoming Department of Revenue
RID: _________________________
th
122 West 25
Street, 2nd West
License: ______________________
Cheyenne WY 82002-0110
Filing Freq: ___________________
NAICS: _______________________
1. Ownership Name:_________________________________________________________ and ____________________________
(Federal Identification Number)
2. Date of first Sale / Service in Wyoming_______/_________/_______________________
3. DBA (Doing Business As Name):_____________________________________________________________________________
4. Please check one of the following that best describes your ownership:
A.
Association/Club
B.
Corporation __________________ __________________
Incorporation Date
State of incorporation
C.
Individual
D.
Limited Partnership
E
Limited Liability Company
F.
Partnership (spousal ownership is considered a partnership)
G.
Other, explain: __________________________________________________________________________________
Note: Corporations must provide evidence of registration with your home state or Wyoming Secretary of State’s office. Please
contact the Wyoming Secretary of State’s office at 307 777-7311 with any questions regarding registration..
5. Location Address:______________________________________________________________________________________
Street
City
State
Zip Code
6. Mailing Address:_______________________________________________________________________________________
Street or PO Box
City
State
Zip Code
7. Internet E-Mail Address:____________________@_______________ Toll Free # (
) __________ - _______________
8. Business Telephone Number: (
) __________ - _____________ Fax Number (
) __________ - _______________
9. Authorized Contact Name: ________________________________________ Telephone Number: (
) ______-__________
10. What Type of Sales does this business make?
Retail
Wholesale
Service
Manufacturer
11. Estimated monthly sales volume: $____________________
12. Describe specifically the type of products and/or services this business provides, (ex: auto parts, computers and/or auto repair, computer
repair) give the percentage of each: total must equal 100%
A. _____________________ _____%
B_____________________ _____%
C. _____________________ _____%
13. Does this business sell liquor? If yes, list your WY Liquor License number ____________________
Yes
No
14. Does this business provide lodging?
Yes
No
15. Does this business have more than one lodging location?
Yes
No
16. Is this business located within the boundaries of an incorporated Wyoming city or town?
Yes
No
17. Does this ownership have more than one location in Wyoming?
Yes
No
18. Has this ownership ever had a Wyoming Sales/Use Tax License?
Yes
No
19. Does this business ship/deliver products and/or service in any other Wyoming city, town or county?
Yes
No
20. Does this business sell cigarettes, cigars, snuff, or other tobacco products?
Yes
No
21. Does this business sell propane, butane, liquefied gas, or compressed natural gas?
Yes
No
22. Would you like to report sales/use tax for all locations under this ownership on one tax return?
Yes
No
If yes please provide the licenses to consolidate. ________________________________________________________
Original signature(s) are required for all ownership types. The business owner must sign for the individual ownership, all partners
must sign for partnership, one major officer for a Corporation, one member or manager must sign for a Limited Liability Company
and Limited Partnership. Attach an additional signature page if needed.
Print Name: __________________________________Signature: __________________________________________Date____________
Address: _____________________________________City: ______________________State: ________Zip: ____________
Last four (4) of Social Security Number: ___________Title: _____________________________ _________________
Print Name: __________________________________Signature: __________________________________________Date____________
Address: _____________________________________City: ______________________State: ________Zip: ____________
Last four (4) of Social Security Number: ___________Title: _____________________________ _________________
Print Name: __________________________________Signature: __________________________________________Date____________
Address: _____________________________________City: ______________________State: ________Zip: ____________
Last four (4) of Social Security Number: ___________Title: _____________________________ _________________
Don’t Forget:
* To complete all lines of this application including all required signatures and attach all required documentation.
*Include the $60.00 non-refundable application fee.
*For assistance completing the application please call at (307) 777-5200.
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