Form Boe-400-Csc - Application For Certificate Of Registration Use Tax Account
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2BOE-400-CSC (FRONT) REV. 1 (10-05)
STATE OF CALIFORNIA
APPLICATION FOR CERTIFICATE OF REGISTRATION
BOARD OF EQUALIZATION
USE TAX ACCOUNT
Use additional sheets to include information for more than two individuals.
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
Limited Liability Company (LLC)
Corporation
SC
(Must provide Articles of Incorporation or
Operating Agreement)
General Partnership
NAICS CODE
BUSINESS
A.C.C.
AREA CODE
Unincorporated Business Trust
CODE
Limited Partnership (LP) *
(Must provide Trust Agreement)
REPORTING BASIS
PROCESSED BY
CERTIFICATE FOR
Limited Liability Partnership (LLP) *
Registered Domestic
PERMIT ISSUE
(Registered to practice law, accounting, or
Partnership
VERIFICATION
DATE
architecture)
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. DATE SALES OR LEASES BEGAN IN CALIFORNIA
(month, day, and year)
6. CORPORATE, LLC, LLP OR LP NUMBER FROM CALIFORNIA SECRETARY OF STATE
7. FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)
CHECK ONE
Owner/Co-Owners
Partners
Registered Domestic
Corp. Officers
LLC Officers/
Trustees/
Partners
Managers/Members
Beneficiaries
Use additional sheets to include information for more than three 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. FULL NAME (first, middle, last)
21. TITLE
22. SOCIAL SECURITY NUMBER (corporate officers excluded)
23. DRIVER LICENSE NUMBER (attach copy)
24. HOME ADDRESS (street, city, state, zip code)
25. HOME TELEPHONE NUMBER
(
)
26. TYPE OF BUSINESS (check one that best describes your business)
Retail
Wholesale
Mfg.
Repair
Service
Construction Contractor
Leasing
27. WHAT ITEMS WILL YOU SELL OR LEASE ?
28. DO YOU MAKE INTERNET SALES?
29. BUSINESS WEBSITE ADDRESS
www.
Yes
No
30. BUSINESS ADDRESS (street, city, state, zip code) [do no list PO Box or mailing service]
31. BUSINESS TELEPHONE NUMBER
(
)
32. MAILING ADDRESS (street, city, state, zip code) [if different from business address]
33. BUSINESS FAX NUMBER
(
)
34. NAME OF PERSON MAINTAINING YOUR RECORDS
35. ADDRESS (street, city, state, zip code)
36. TELEPHONE NUMBER
(
)
37. ADDRESS WHERE BOOKS AND RECORDS, SUITABLE FOR AUDIT PURPOSES, ARE MAINTAINED (street, city, state, zip code)
38. OTHER BOARD ACCOUNT NUMBERS
39. PROJECTED MONTHLY GROSS SALES IN CALIFORNIA
40. PROJECTED MONTHLY TAXABLE SALES IN CALIFORNIA
$
$
41. NAME OF BANK OR OTHER FINANCIAL INSTITUTION (note whether business or personal)
42. BANK BRANCH LOCATION
43. NAME OF MERCHANT CREDIT CARD PROCESSOR (if you accept credit cards)
44. MERCHANT CARD ACCOUNT NUMBER
(continued on reverse)
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