Form Cr-17 - Kansas Registration Schedule For Additional Business Locations
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1KANSAS REGISTRATION SCHEDULE
FOR ADDITIONAL BUSINESS LOCATIONS
RCN - FOR OFFICE USE ONLY
EIN ___ ___
___ ___ ___ ___ ___ ___ ___
Use this schedule to register a business location in addition to the one listed in Part 4 of Form CR-16. Complete this form for each new or additional
location. You must provide the following information for each new or additional location(s) so that your customer profile can be maintained with the
most current information. A new Kansas customer identification number is not required for additional locations; report all sales for the new or
additional location(s) under your current customer identification number.
Check the box for each tax type, license or registration needed for the location listed below.
Retailers' Sales Tax
Tire Excise Tax
Liquor Drink Tax
Retailers' Compensating Use Tax
Vehicle Rental Excise Tax
Cigarette Vending Machine Permit
Dry Cleaning Surcharge
Retail Cigarette License
Consumers' Compensating Use Tax
Transient Guest Tax
Liquor Enforcement Tax
Water Protection/Clean Drinking Water Fee
1. Trade Name of Business:
2. Business Location:
(Street address - Do not enter PO Box)
(City)
(State)
(County)
(School District)
(Zip)
No
3. Is the business located within the city limits?
Yes
If yes, what city?
4. Describe the primary business activity at this location: ___________________________________________________________________________
Enter business classification (if known): NAICS Code _____________________
(
)
5. Business Telephone Number:
6. Date location opened under this ownership: Month _________________ Day ______ Year _______
7. Do you ship or deliver merchandise to Kansas customers?
No
Yes
8. Will sales be made from various temporary locations?
No
Yes
9. If your business is seasonal, list the months you operate: _________________________________________________________________________
10. Is your business engaged in the renting or leasing of motor vehicles?
No
Yes
If yes, are the leases for more than 28 days?
No
Yes
11. Do you make retail sales of cigarettes over-the-counter, by mail, telephone, or over the internet?
No
Yes
If yes, you must enclose a $25.00 fee for each location with this application.
If you plan to sell cigarettes over the internet, telephone or via mail order, please provide your e-mail or web page address. ____________________
If yes, you must enclose an additional page listing the serial
12. Will you be the operator of cigarette vending machines?
No
Yes
number and manufacturer's brand name of each machine. Enclose a check or money order for $25.00 for each machine with this application.
13. Is this location a hotel, motel or bed & breakfast?
No
If yes, how many rooms are available for rent or lease? __________
Yes
14. Do you sell new tires and/or vehicles with new tires?
No
Yes
Estimate your monthly tire tax (25 cents per new tire). $____________
15 If you are a dry cleaner or laundry retailer, do you have satelite locations or agents in businesses not classified as a dry cleaning or laundry
facility?
No
Yes
If yes, please enclose an additional page listing the name, type of business, address, city, state and zip code of
each satelite location.
16. If you are registering an additional location for Liquor Drink tax, enter the date of first sale of alcoholic beverage at this location:
Month __________ Day _____ Year ______
Check type of license:
Hotel (Entire premises)
Drinking Establishment
Class "A" Club
Class "B" Club
Caterer
Hotel/Caterer
DE/Caterer
Class "B" Reciprocal Club
No
Yes
17. Are you a public water supplier making retail sales of water delivered through mains, lines or pipes?
If yes, you must also have a Kansas Motor Fuel Retailers
No
Yes
18. Do you make retail sales of motor vehicle fuels or special fuels?
License. The license application, Form MF-53, is available from our web site or office. Complete a separate application for each retail location.
Return this form (with payment, if applicable) to:
Kansas Department of Revenue, 915 SW Harrison St., Topeka, KS 66625-9000 or fax to: 785-291-3614
CR-17
For assistance call: 785-368-8222
(Rev. 10/04)
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