Form Boe-400-Mco - Application For Seller'S Permit And Registration As A Retailer (Corporations/limited Liability Company/organizations) - 2003 Page 2

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BOE-400-MCO (BACK) REV. 12 (1-03)
35. FORMER OWNER’S NAME
36. SELLER’S PERMIT ACCOUNT NUMBER
37. IF AN ESCROW COMPANY IS REQUESTING A TAX CLEARANCE ON YOUR BEHALF, PLEASE LIST THEIR NAME, ADDRESS, TELEPHONE NUMBER AND THE ESCROW NUMBER
38. DO YOU MAKE INTERNET SALES?
39. WEBSITE ADDRESS
Yes
No If yes, answer 39.
40. IF ALCOHOLIC BEVERAGES ARE SOLD, PLEASE LIST YOUR ALCOHOLIC BEVERAGE CONTROL LICENSE NO. AND TYPE
41. NAME, ADDRESS & TELEPHONE NUMBER OF PERSON MAINTAINING YOUR RECORDS
42. NAME, ADDRESS & TELEPHONE NUMBER OF BUSINESS LANDLORD
43. NAME & LOCATION OF BANK OR OTHER FINANCIAL INSTITUTION (note whether business or personal)
CHECKING ACCOUNT NUMBER(S)
SAVINGS ACCOUNT NUMBER(S)
44. NAMES & ADDRESSES OF MAJOR SUPPLIERS
PRODUCTS PURCHASED
SECTION III: SALES AND EMPLOYER INFORMATION
45. PROJECTED MONTHLY SALES (if unknown, enter an estimated amount)
Total gross sales
$
Taxable sales $
46. INFORMATION CONCERNING EMPLOYMENT DEVELOPMENT DEPARTMENT (EDD)
Are you registered with EDD? .........................................................................................................
Yes
No
If no, will your payroll exceed $100 per quarter? ............................................................................
Yes
No
If yes, you must apply with EDD.
Number of employees
(See pamphlet DE 44, California Employer’s Guide )
I received pamphlet DE 44, California Employer’s Guide . ............................................................
Yes
No
CERTIFICATION
The corporate officer or officer of the organization must sign below.
I am duly authorized to sign the application and certify that the statements made are correct to the best of my knowledge and belief.
I also represent and acknowledge that the applicant will be engaged in or conduct businesses as a seller of tangible personal property.
NAME (typed or printed)
SIGNATURE
DATE
✍
NAME (typed or printed)
SIGNATURE
DATE
✍
NAME (typed or printed)
SIGNATURE
DATE
✍
NAME (typed or printed)
SIGNATURE
DATE
✍
FOR BOARD USE ONLY
Furnished to Taxpayer
REPORTING BASIS
FORMS
PUBLICATIONS
BOE-8
BOE-400-Y
PUB 73
PUB DE 44
SECURITY REVIEW
BOE-162
BOE-519
BOE-598
$
BOE-467
BOE-1009
BY
BOE-1241-D
APPROVED BY
RETURNS
REGULATIONS
REMOTE INPUT DATE
REG. 1668
REG. 1698
BY
REG. 1700
Permit Issued Date
CLEAR
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