Form Boe-400-Mip (S2f) - Application For Seller'S Permit And Registration As A Retailer (Individuals/partners) Page 2

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BOE-400-MIP (S2B) REV. 11 (5-97)
14. NAME, ADDRESS & TELEPHONE NUMBER OF ACCOUNTANT/BOOKKEEPER
15. NAME, ADDRESS & TELEPHONE NUMBER OF BUSINESS LANDLORD
16. NAME & LOCATION OF BANK OR OTHER FINANCIAL INSTITUTION (Note whether business or personal)
CHECKING AND SAVINGS ACCOUNT NUMBER
17. NAME & ADDRESS OF MAJOR SUPPLIERS
PRODUCTS PURCHASED
18. OTHER ACCOUNT NUMBERS ISSUED TO YOU BY THE BOARD
SECTION III: INCOME AND EXPENSES
3. INFORMATION CONCERNING EMPLOYMENT DEVELOPMENT DEPARTMENT
2. PROJECTED MONTHLY
1. PROJECTED MONTHLY
(EDD)
SALES
BUSINESS EXPENSES
a. Are you registered with EDD?
Yes
No
b. If no, will your payroll exceed $100 per quarter?
Yes
No
TOTAL GROSS SALES
$
RENT
$
If yes, you must make application with EDD.
NON-TAXABLE
$
PAYROLL
$
Number of employees
See pamphlet DE 44, “California Employer's Guide.”
TAXABLE
$
MISC.
$
c. I have already received pamphlet DE 44,
“California Employer's Guide.”
Yes
No
TAX
$
TOTAL
$
SECTION IV: 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. (If spouse co-ownership both signatures must appear below.)
SIGNATURE
TITLE
SIGNATURE
TITLE
(typed or printed)
(typed or printed)
NAME
NAME
DATE
FOR BOARD USE ONLY
Furnished to Taxpayer
REPORTING BASIS
REGULATIONS
BT-8
DE-44
X
SECURITY REVIEW
BOE-324A
OTHER
BT-400Y
____________
BT-598 $_________
BT-467
____________
PAMPHLETS
BT-1009
BT-519
____________
BY
BT-1241C
____________
APPROVED BY
REG. 1668
____________
REMOTE INPUT DATE
RETURNS
REG. 1698
____________
BY
REG. 1700
____________
Permit Issued Date ______________

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