Form Boe-400-Csl - Application For Certificate Of Registration Lender Account - 2005
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2BOE-400-CSL (FRONT) REV. 1 (10-05)
STATE OF CALIFORNIA
APPLICATION FOR CERTIFICATE OF REGISTRATION
BOARD OF EQUALIZATION
LENDER ACCOUNT
1. TyPE OF OwNERShIP (check one)
* Must provide partnership agreement
FOR BOARD USE ONLY
Sole Owner
husband/wife Co-ownership
TAX
IND
OFFICE
ACCOUNT NUMBER
Corporation
Limited Liability Company (LLC)
(Must provide Articles of Incorporation or Operating Agreement)
General Partnership
NAICS CODE
BUSINESS A.C.C.
AREA CODE
Unincorporated Business Trust
Limited Partnership (LP) *
CODE
(Must provide Trust Agreement)
REPORTING BASIS
Registered Domestic
Limited Liability Partnership (LLP)*
PROCESSED By
CERTIFICATE ISSUE
Partnership
DATE
(Registered to practice law, accounting, or architecture)
VERIFICATION
DL
PA
Other
Other (describe)
___ / ___ / ___
2. NAME OF SOLE OwNER, CORPORATION, LLC, PARTNERShIP, OR TRUST
3. STATE OF INCORPORATION OR ORGANIZATION
4. BUSINESS TRADE NAME [DBA] (if any)
5. FEDERAL EMPLOyER IDENTIFICATION NUMBER (FEIN)
6. CORPORATE, LLC, LLP OR LP NUMBER FROM CALIFORNIA SECRETARy OF STATE
7. RETAILER - PROVIDE SELLER’S PERMIT NUMBER
CHECK ONE
Owner/Co-Owners
Partners
Registered Domestic Partners
Corp. Officers
LLC Officers/
Trustees/
Managers/Members
Beneficiaries
Use additional sheets to include information for more than two individuals.
8. FULL NAME (first, middle, last)
9. TITLE
10. SOCIAL SECURITy NUMBER (corporate officers excluded)
11. DRIVER LICENSE NUMBER (attach copy)
12. hOME ADDRESS (street, city, state, zip code)
13. hOME TELEPhONE NUMBER
(
)
14. FULL NAME (first, middle, last)
15. TITLE
16. SOCIAL SECURITy NUMBER (corporate officers excluded)
17. DRIVER LICENSE NUMBER (attach copy)
18. hOME ADDRESS (street, city, state, zip code)
19. hOME TELEPhONE NUMBER
(
)
20. BUSINESS ADDRESS (street, city, state, zip code) [do not list PO Box or mailing service]
21. BUSINESS TELEPhONE NUMBER
(
)
22. MAILING ADDRESS (street, city, state, zip code) [if different from business address]
23. BUSINESS FAX NUMBER
(
)
24. DO yOU MAKE INTERNET SALES?
25. BUSINESS wEBSITE ADDRESS
www.
yes
No
26. NAME OF BANK OR OThER FINANCIAL INSTITUTION (note whether business or personal)
27. BANK BRANCh LOCATION
28. NAME OF PERSON MAINTAINING yOUR RECORDS
29. ADDRESS (street, city, state, zip code)
30. TELEPhONE NUMBER
(
)
31. ADDRESS whERE BOOKS AND RECORDS, SUITABLE FOR AUDIT PURPOSES, ARE MAINTAINED (street, city, state, zip code)
32. NAMES OF MAJOR ASSIGNEES OF ACCOUNTS
33. ADDRESS (street, city, state, zip code)
34. TELEPhONE NUMBER
(
)
(
)
(
)
(
)
(continued on reverse)
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