Form Boe-400-Mcu - Application For Consumer Use Tax Account Page 2
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2BOE-400-MCU (BACK) REV. 9 (10-03)
36. NAME, ADDRESS & TELEPHONE NUMBER OF BUSINESS LANDLORD
37. NAME, ADDRESS AND TELEPHONE NUMBER OF PERSON MAINTAINING YOUR RECORDS
38. NAME & LOCATION OF BANK OR OTHER FINANCIAL INSTITUTION (Note whether business or personal)
39. CHECKING ACCOUNT NUMBER(S)
40. SAVINGS ACCOUNT NUMBER(S)
41. NAMES & ADDRESSES OF MAJOR SUPPLIERS
42. PRODUCTS PURCHASED
CERTIFICATION
The statements contained herein are hereby certified to be correct to the best knowledge and belief of the undersigned who
is duly authorized to sign this application. (Signature of owners, partners
corporate officers, or officers or authorized
,
representative of the organization is required.)
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-1009
BOE-467
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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