Department of Revenue Services
RESET
Connecticut Tax Registration Number
State of Connecticut
PO Box 2937
REG-7
Hartford CT 06106
(Rev. 08/08)
Application for Authority to Collect
Connecticut Use Tax
Read the instructions on the back before you complete this application.
Complete the application in blue or black ink only.
1. Business Name and Address
Organization Name: Enter name of sole proprietor, partnership, corporation, or LLC
Federal Employer Identifi cation Number (FEIN)
Business Trade Name
Business Location: Enter physical address of the business. PO Box or rural route number is not acceptable.
Address Line 1
Address Line 2
City
State
ZIP Code
Mailing Address Line 1 (Street or PO Box)
Address Line 2
City
State
ZIP Code
Business Telephone Number
Email Address
Bank Name
(
)
2. Business Information
Type of Organization:
Sole Proprietorship
Limited Liability Company (LLC)
S Corporation
Check if taxed as a corporation
Check if taxed as an S corporation
General Partnership
Single Member LLC (SMLLC)
Corporation
Check if taxed as a corporation
Check if taxed as an S corporation
Limited Liability Partnership (LLP)
Limited Partnership
Other (explain):
Check if taxed as a corporation
Enter the date this business started or will start
If a corporation, give the state of incorporation.
/
/
making sales for use in Connecticut.
_____
______
___________
________________________________________________________
3. Nature of Business Activity
Check the box(es) that best describe your business:
Retailer
Wholesaler
Manufacturer
Service Provider
Other (explain): _______________________________________________________________________________________
4. Major Business Activity
Describe your major business activities: ______________________________________________________________________
______________________________________________________________________________________________________
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