Form 21-007a - Questionnaire 21-007 - Iowa Customer/dealer
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Iowa Department of Revenue
Questionnaire 21-007 - Iowa Customer/Dealer
Enter the reference number from our letter here: ___________________________
It is important that you sign the last page of the questionnaire.
Please provide a detailed explanation when requested. If more room is needed, attach a separate page.
1. Does an employee from this supplier currently visit your Iowa office(s) or location(s)?
Yes ____ No ____
How Often? __________________________________________________
2. For all employees from this supplier who visit or have visited your Iowa office(s) or location(s), please
complete the following:
Name
Title & Phone
How often does he/she visit:
Weekly
Monthly
Yearly
_________________________
__________________________
________
_________
______
_________________________
__________________________
________
_________
______
_________________________
__________________________
________
_________
______
_________________________
__________________________
________
_________
______
_________________________
__________________________
________
_________
______
3. If no supplier employee visits your Iowa office(s) or location(s), do you transact your business:
Yes
No
a. by telephone or telemarketing?
_____
_____
b. by mail or catalog?
_____
_____
c. through a dealer?
_____
_____
d. through a non-employee representative?
_____
_____
e. through a non-Iowa location? (Other than the supplier’s location)
_____
_____
f. through a non-Iowa purchasing department?
_____
_____
g. Other? _____________________________________________
_____
_____
For any yes answers to questions 3(c) to 3(g), please provide the names, addresses, and phone numbers of
any individuals or companies that apply.
Name & Address
City, State
Zip
(Area Code) Phone
___________________________________
_______________________
_____
___________
___________________________________
_______________________
_____
___________
___________________________________
_______________________
_____
___________
___________________________________
_______________________
_____
___________
___________________________________
_______________________
_____
___________
21-007a (04/20/11)
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