Form Bls-700-028 Mba - Master Application Page 3
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43. Business Information (continued)
d.
Estimated Gross Annual Income in Washington
Please check one box that applies to your business:
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!
!
!
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0 - $12,000
$12,001 - $28,000
$28,001 - $60,000
$60,001 - $100,000
$100,001 and above
e.
Please indicate which of these business activities you do in Washington State (check all that apply):
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!
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Wholesale
Retail
Manufacturing
Services
f.
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)
g.
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!
!
Did you buy, lease, or acquire all or part of an existing business?
No
All
Part
/
/
Date bought/leased/acquired:
Prior Business Name
MM
DD
YY
(
)
Prior Owner’s Name
Telephone Number
h.
!
!
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: $
i.
If this business is owned by, controlled by, or affiliated with any other business entity, please indicate that business entity's name:
j.
If you are changing your business structure, ( such as changing from sole proprietorship to corporation) and want the
old account closed, please indicate the UBI number to be closed:
k.
If you have ever owned another business, please provide:
Business Name
UBI Number
l.
List your bank’s name:
Do you plan to have employees or wish to register for optional coverage?
(Some LLC members are considered to be employees .
For further information on optional coverage definitions, see License Fee Sheet)
! ! ! ! !
! ! ! ! !
Yes
No
If NO
, skip to section 5.
If YES
, complete sections 4 and 5.
BLS-700-028 MBA (R/06/06) OR/W Page 3 of 4
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