Form Bls-700-322 - Sellers Of Travel Registration Addendum
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1
2State of Washington
UBI
Business Licensing Service
PO Box 9034
Owner name
Olympia, WA 98507-9034
1-800-451-7985
Sellers of Travel Registration Addendum
This form must be submitted with a Business License Application form.
Please type or print in dark ink.
Registration fee: $202
A
Proof of business registration Applicants from outside Washington only
If your business is located outside of Washington State, you must provide proof of holding a valid registration to conduct
business in your home state. Attach a copy of your current business registration document, or other official registration
certification provided by the registration office in your home state.
B
Criminal history All applicants
The questions below apply to all owners, partners, officers, LLC or LLP Members or Managers or any other principal
of any business entity. If any principal in your business has had any convictions or judgements entered as described
below, you must answer “yes” to the questions.
1. Have you been convicted of a crime, misdemeanor, or felony in this state, any other state, any other
Yes
No
jurisdiction, or by the federal government within the past ten (10) years? ...........................................
2. Is there a criminal complaint, accusation, or information presently pending, or currently under
Yes
No
indictment in this state, any other state, any other jurisdiction, or by the federal government? ...........
3. Has any professional or occupational license, certification or permit been fined, suspended,
revoked, refused or denied in this state, any other state, any other jurisdiction, or by the federal
Yes
No
government? ........................................................................................................................................
4. Have you ever had a civil court order, verdict, or judgment entered in any court of competent
Yes
No
jurisdiction in this state, any other state, any other jurisdiction, or by the federal government? ..........
If you marked “yes” to any of the questions, you must attach an explanation listing the charge(s); the date(s) of
the conviction(s), civil judgement(s) or order(s); the county and/or state jurisdiction(s) involved; and the final
disposition of the charge(s).
C
Identification of authorized agents All applicants
Below, list all employees, independent contractors, or other outside agents who will sell travel under the authority of
this business location’s registration. Attach additional sheets in the same format, if necessary.
Business address
Business telephone
Name
number
Street or route, city, state, zip code
(
)
(
)
(
)
(
)
(
)
Check here if you do not have employees, independent contractors or agents.
Continued on next page
For assistance or to request this document in an alternate format, visit or call 1-800-451-7985. Teletype (TTY) users may call 360-705-6718.
BLS-700-322 (5/20/11) Page 1 of 2
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