Form Bls-700-028e - Business License Application Page 3
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44. Location / Business Information
a.
are you an out-of-state business with no Washington location and have employees or representatives working in Washington?
Yes
No
If yes, provide one of their Washington addresses (we will not use this address for mailing purposes):
Business Street address
City
State
Zip code
(Do not use a PO Box or PMB Address)
b.
Do you plan to hire independent contractors or people you will report on a 1099 form?
Yes
No
Check “Independent Contractors” definition at
c.
provide the estimated gross annual income in Washington
(check the one box that applies to your business):
$0 - $12,000
$12,001 - $28,000
$28,001 - $60,000
$60,001 - $100,000
$100,001 and above
d.
Mark the business activities in Washington State (check all that apply):
Wholesale
Retail
Manufacturing
Services
e.
Describe in detail the principal products or services you provide in Washington State--failure to provide this information will
cause delay in processing your application:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
f.
Did you buy, lease, or acquire all or part of an existing business?
No
all
part
/
/
Date bought/leased/acquired: __________________________
______________________________________________
MM
DD
YY
prior Business Name
(
)
__________________________________________________
______________________________________________
prior owner’s Name
Telephone Number
g.
Did you purchase/lease any fixtures or equipment on which you have not paid sales or use tax?
Yes
No
If yes, indicate purchase or lease price: $ ________________
h.
If this business is owned by, controlled by, or affiliated with any other business entity, provide that business entity’s name:
__________________________________________________________________________________________________
i.
If you are changing your business structure (such as changing from sole proprietorship to corporation) and want the
old account closed, provide the UBI number to be closed: _____________________________________________________
Do you wish to cancel all the trade names registered under the old UBI number?
Yes
No
You must re-register all trade names you use under the new business structure.
j.
If you have ever owned another business, provide: ____________________________________
___________________
Business Name
UBI Number
k.
provide your bank’s name: _______________________________ Branch: ______________________________________
If you plan to have employees or wish to register for elective coverage for owners or excluded employees, complete Section 5.
(For information see the Industrial Insurance or Unemployment Insurance sections on the License Fee Sheet.)
BLS-700-028e (11/21/13) page 3 of 4
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