Business Registration And Retail Sales Tax Application Form - 2011 Page 2
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TYPE OF OWNERSHIP (Check One)
____ Individual/Sole Proprietor
____ Corporation
____ Partnership
____ Ltd. Liability Company
If you checked “Corporation” complete the following:
Corporate Registered Agent_________________________________________________ Federal ID #
-______________________
____ Tax Exempt/Non-Profit Organization: Nature of Business________________________________________________________
Submit documentation to verify this statement. Provide State of Colorado Tax Exempt Number 98-__________________________
____________________________________________________________________________________________________________
NAME & HOME ADDRESSES OF THE REPRESENTATIVES OF THE BUSINESS (attach schedule if needed)
Name__________________________________ Position________________________ Home Phone # (_____)__________________
Home Address_____________________________________ City___________________ State______ Zip Code_________________
Driver’s License #/State______________________________ SS#_______-______-_______ Date of Birth_______-_______-_______
………………………………………………………………………………………………………………………………………………
Name__________________________________ Position________________________ Home Phone # (_____)__________________
Home Address_____________________________________ City___________________ State______ Zip Code_________________
Driver’s License #/State______________________________ SS#_______-______-_______ Date of Birth_______-_______-_______
………………………………………………………………………………………………………………………………………………
Name__________________________________ Position________________________ Home Phone # (_____)__________________
Home Address_____________________________________ City___________________ State______ Zip Code_________________
Driver’s License #/State______________________________ SS#_______-______-_______ Date of Birth_______-_______-_______
………………………………………………………………………………………………………………………………………………
Name__________________________________ Position________________________ Home Phone # (_____)__________________
Home Address_____________________________________ City___________________ State______ Zip Code_________________
Driver’s License #/State______________________________ SS#_______-______-_______ Date of Birth_______-_______-_______
____________________________________________________________________________________________________________
NATURE OF BUSINESS: (Check any that apply)
____ Financial/Leasing
____ Hotel/Motel
____ Construction
____ Wholesale
____ Manufacturing
____ Nightclub/Bar
____ Restaurant
____ Recreation/Sporting
____ Retail - Liquor
____ Retail - Grocery
____ Retail - Other
____ Direct Sales
____ Service
____ Office
____ Medical
____ Other
____ Mail Order/Internet Sales
____ Utility - Communications/Telecom
____Utility - Other
What do you sell/lease? ________________________________________________________________________________________
Do you charge an Admission Fee or Cover Charge upon entry?
_______ Yes
______ No
Colorado Sales Tax Number (REQUIRED FROM ALL RETAIL BUSINESSES) ________________________________________
____________________________________________________________________________________________________________
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Parent category: Life