Form Wv/brt-Fr - Foreign Retailer Voluntarily Collecting And Remitting Use Tax On Sales To West Virginia Customers

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WV/BRT-FR
Rev. 08-13
West Virginia State Tax Department
Revenue Division
P. O. Box 2666
Charleston, West Virginia 25330-2666
FOREIGN RETAILER VOLUNTARILY COLLECTING AND REMITTING
USE TAX ON SALES TO WEST VIRGINIA CUSTOMERS
This form must accompany the Business Application if you answered yes on line 14A of the WV/BUS-APP Rev. 01-13
(Line 19B of WV/BUS-APP Rev. Nov. 09)
A business located outside of West Virginia which collects West Virginia Use Tax on its sales to West Virginia residents or businesses for use
in West Virginia may not be subject to other West Virginia business taxes. In order for us to properly register this business, please answer
the following questions:
1.
What is your West Virginia Tax Identification Number? ____________________________. If one has not been assigned, please indicate
your federal employer’s identification number (FEIN). ___________________________________________________________________
What is the name and location of your business? _______________________________________________________________________
________________________________________________________________________________________________________________
What is the mailing address of your business, if different from above? ______________________________________________________
________________________________________________________________________________________________________________
2.
Check whether or not any of the activities below are engaged within West Virginia:
YES
NO
a.
Maintenance of business location of any kind (i.e. office, warehouse, place of distribution,
repair shop, display room).
___
___
b.
Ownership or maintenance of stock of goods in a warehouse or on consignment.
___
___
c.
Ownership or maintenance of stock of goods in hands of a distributor or other nonemployee
representative, including an independent contractor.
___
___
d.
Operation of mobile stores (i.e. trucks with driver/salesman) or delivery of goods from
company-owned vehicles.
___
___
e.
Operation of any employees, representatives, agents, independent contractors, or salespersons,
whether in-state or out-of-state residents, who solicit orders without authority to accept them.
___
___
f.
Operation of any employees, representatives, agents, independent contractors, or salespersons,
whether in-state or out-of-state residents, who solicit and accept orders.
___
___
g.
Ownership of or renting of any real or personal property, including motor vehicles, which is
directly or indirectly used to produce income.
___
___
h.
Leasing of tangible personal property or licensing of intangible rights for use in the state.
___
___
i.
Performance of construction contracts or personal service contracts.
___
___
j.
Performance of services, including supervision of or actual installation, repair, or assembly
of machinery, equipment or merchandise sold either by this company or by another company.
___
___
If you marked yes to any of the questions on this questionnaire, then you must first register with the Secretary of State’s Office.
I have examined this document and to the best of my knowledge and belief, it is true and correct
.
_____________________________
______________________
___________________
_____________________
SIGNATURE (REQUIRED)
TITLE
DATE
PHONE
If you have any questions, call (304) 558-3333 or 1-800-982-8297 toll free. Return completed form to:
West Virginia State Tax Department
Revenue Division
P. O. Box 2666
Charleston WV 25330

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