Form Com/rad-097 - Maryland Sales And Use License Application For Out-Of-State Vendors

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Maryland Sales and Use License Application
For Out-of-State Vendors
_ _ _
_ _ _
_ _ _ _
-
Telephone number:
-
a) Federal employer ID number:
Type of ownership:
b) Social Security number of owner, officer, or
agent responsible for taxes:
❒
❒
Sole proprietorship
Partnership
❒
❒
Non-Maryland
Other:
corporation
D escribe
Legal name of entity owner:
Will you have employees with wages subject to Maryland
withholding or performing services in Maryland?
❒
❒
Trade name, if different:
Yes
No
Describe business activity which generates revenue:
Mailing address:
Street
City
State
ZIP Code
Identify owners, partners, corporate officers.
Name
Title
Address
Telephone number
I declare under penalty of perjury that this application has been examined by me and to the best of my knowledge and belief is true, correct, and complete.
Sign here
Title
Date
Rev. 10/07
Fax this application to Central Registration at 410-974-3456 or mail to:
Form COM/RAD-097
Comptroller of Maryland, Central Registration, Revenue Administration Center,
Annapolis, MD 21411-0001

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