Form Boe-400-Er - Application For Electronic Waste Recycling Fee Account

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BOE-400-ER (FRONT) REV. 4 (9-07)

STATE OF CALIFORNIA

APPLICATION FOR ELECTRONIC WASTE RECYCLING FEE ACCOUNT

BOARD OF EQUALIZATION

SECTION I: SALES OR USE TAX ACCOUNT INFORMATION

FOR BOARD USE ONLY

1. PLEASE ENTER YOUR SALES AND/OR USE TAX ACCOUNT NUMBER(S) (if registered with the Board of Equalization)

ELECTRONIC WASTE RECYCLING FEE

General Information

Beginning January 1, 2005, the retail sale of covered electronic devices (CEDs) is subject to the electronic waste recycling

fee. If you are a retailer who sells devices covered by the fee, you must register with the Board of Equalization (Board),

collect the fee from your customers, file quarterly fee returns, and pay the collected fees to the Board.

For more information on the fee, see our website:

Registration Requirements

To register for the fee, please complete, sign, date, and return this application in person or by mail. Be sure to complete all

four sections. We cannot process your application if it is incomplete or if you do not sign in Section IV. Be sure to record

your seller's permit number or use tax account number in Section I above. Your registration may be delayed without this

information.

Filing Requirements

Feepayers are required to file a return and pay the fees on a quarterly basis. Your return and payment will be due on or

before the last day of the month following the end of the calendar quarter (the due date is the last day of the month

following the reporting period). You must file a return every quarter even if you do not collect any fees. Depending on

your fee collections, we may require you to file returns and pay the fee on a monthly or yearly basis instead of quarterly.

SECTION II: OWNERSHIP INFORMATION

2. PLEASE CHECK TYPE OF OWNERSHIP

Sole Owner

Husband & Wife Co-Ownership

Registered Domestic Partnership

Limited Partnership

General Partnership

Corporation

Limited Liability Company (LLC)

Other

3. OWNER NAME(S) (include all individual owners, general partners or full corporate, limited liability company (LLC), or organization name) (attach additional page if necessary)

SECTION III: BUSINESS INFORMATION

4. BUSINESS OR TRADE NAME (DBA if any)

5. BUSINESS TELEPHONE NUMBER

6. BUSINESS EMAIL ADDRESS

7. BUSINESS WEBSITE ADDRESS

(

)

www.

8. BUSINESS ADDRESS (do not list PO Box or mailing service)

CITY

STATE

ZIP CODE