FORM 4458
PAGE 2
YES
NO
9. Does your company, or any affiliated company, maintain a bank account in this state?
10. Does your company currently have or has it ever had a security interest in any real or personal property sold or
located in this state?
11. Does your company currently have or has it ever had advertising material in this state? (attach a copy)
12. Is your company listed in any telephone or building directory in this state? (attach a copy)
13. Does your company currently engage or has it engaged in any advertising (cooperative or otherwise) in this state?
14. Have any contracts been executed by your company in this state? (attach a copy)
If yes, give detailed location, dates and value of contract(s):
15. Have you had employees, associates, or representatives performing services in this state?
As to any such representatives who are engaged in some form of sales, promotional, or technical service work on your
behalf, please provide the following information:
a) Identification of representatives:
Designation of
Year or
Territory Covered
Name and Address
Representative
Years
b) Do you have a standard form of written agreement with the representatives? (attach a copy)
c) Does the representative sell or represent other lines of merchandise other than yours?
d) How is remuneration made (commission only, salary and commission, expense allowance, etc.)?
16. Do any of the employees, associates, or representatives:
Call upon customers in this state to collect on delinquent accounts?
Call upon customers in this state to accept installments?
Make adjustments for returned or damaged merchandise?
Investigate or authorize credit of existing or potential customers in this state?
Investigate customer’s complaints in this state?
Authorize warranty work or replacement of merchandise?
Receive purchase orders when calling upon a customer in this state?
(If yes, do they have authority to approve or reject the order?)
Pick up returned, damaged and/or out-of-date merchandise from customer?
Make “on the spot” sales to customers?
Distribute or carry any type of samples, brochures, etc.? If yes, who owns samples, brochures, etc.?
Inspect the marketing of your products or any use of your trademarks or tradenames?
Accept deposits or down payments?
Accept installments and/or collections on delinquent accounts?
17. Do your employees, associates, or representatives maintain an office of any kind, either in their home or elsewhere
within this state?
If yes, do they:
a) Store inventory there?
b) Store samples there?
c) Maintain a telephone listing under the company’s name?
d) Receive any office expense reimbursement from the company?
18. Do your employees, associates, or representatives assist dealers or other customers in any of the following ways:
Training their employees in the sale, service, or use of your product?
Organize dealer sales promotions?
Call on dealer’s customers accompanied by dealer’s salesmen?
Set up merchandise or advertising displays?
Other
19. What type of customers or prospects do the employees, associates, or representatives call on (i.e., wholesalers,
retailers, industries, home, etc.)?
MO 860-2629 (08-2010)