Form S-101 - Application For Direct Pay Permit - 1998
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1APPLICATION FOR DIRECT PAY PERMIT
WISCONSIN DEPARTMENT OF REVENUE
Income, Sales & Excise Tax Division
Complete this entire form including answers to all questions
Compliance
Bureau
below.
Send the original to the Wisconsin Department of
PO Box 8902
Madison WI
53708-8902
Revenue.
Retain a copy for your records.
FOR DEPARTMENT USE ONLY
Direct Pay Permit Number
Date Issued
Print Name of Applicant
Seller’s Permit or Use Tax
Registration Certificate Number
Address (Number and Street or Rural Route)
Federal Employer ID Number
City or Post Office
S t a t e
Zip Code
C o u n t y
P h o n e
Name of Contact Person
(
)
Type of Business
SIC Code
1. Do you regularly make purchases of tangible personal property or taxable services under circumstances where it is
difficult to determine whether the property will be subject to sales or use taxes?
Y e s
N o *
If Yes, what is the approximate annual amount of these purchases (excluding purchases for resale) that would be subject
to use tax in Wisconsin? $_________________
2. Will the use of a direct pay permit significantly reduce your work in administering sales and use taxes?
Y e s
N o *
3. Will your accounting system clearly indicate the amount of tax owed when items are purchased without tax using a
Direct Pay Permit?
Y e s
N o *
*
If you answered no to questions 1 or 2 above, please attach an explanation of why you are applying for a direct pay
permit.
If you answered no to question 3, attach an explanation of how you will determine your tax liability.
CERTIFICATION
I certify that the above statements are correct to the best of my knowledge and that I am authorized to sign the application.
S i g n a t u r e
D a t e
T i t l e
Print Name
A Direct Pay Permit will be mailed to you if your application is approved.
This permit allows a purchaser to purchase taxable
tangible personal property and certain taxable services without Wisconsin sales and use tax, even though no exemption
applies.
Use tax is then reported by the purchaser when the property or service is stored, used, or consumed in a taxable
m a n n e r .
S-101 (R. 9-98)
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