Sales Tax License Application Form - City And County Of Broomfield

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City and County of Broomfield, One DesCombes Drive, Broomfield CO 80020
Finance Department, Sales Tax Division
Sales Tax License Application
NO FEE REQUIRED
CART/KIOSK DEPOSIT $200.00
E-Mail:
Web:
303-464-5811 FAX 303-410-3802
Licenses will not be issued unless this form is filled out completely.
CART/KIOSK DEPOSIT MUST ACCOMPANY APPLICATION
Please allow up to two weeks for processing of application. Please Print
Business Information
Business Name______________________________________________________________________________
DBA Name (if different)________________________________________________________________________
Physical Address_____________________________________________________________________________
City______________________________________State_______________________Zip____________________
Business Phone__(____)_____________________Business Fax__(____)_______________________________
Business Web Address________________________________Business E-Mail___________________________
Mailing Information
Contact Person______________________________________________________________________________
Mailing Address______________________________________________________________________________
City______________________________________State_______________________Zip___________________
_
Owner/Officer Information
_________________________________________Phone number/Address_______________________________
_________________________________________Phone number/Address_______________________________
Type of Ownership Individual/Sole Proprietor_____ Partnership_____ LLC_____ Corporation_____ Trust_____
Type of Location
Commercial__________
Home Based_________
FEIN or Social Security Number____________________ State Sales Tax Number______________________
Reporting Frequency Monthly________ Quarterly_________ Annually_________
Registered with the Secretary of State in Colorado
Yes_____
No_____
New Business in Broomfield Yes______ No______
Purchased Existing Business Yes_____ No______
Date you will start business in Broomfield__________________________
Description of business (please detail types of services/products and nature of business)__________________
___________________________________________________________________________________________
I declare under penalty of perjury, that this application has been examined by me and the statements made herein are made in good
faith pursuant to Colorado tax laws and regulations, and to the best of my knowledge and belief, are true, correct and complete.
SIGNATURE________________________________________
DATE______________________________
Account Number Issued________________ Date Entered_________________________

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