Vt Form Br-400 (Formerly Form S-1) - Application For Business Tax Account Page 5
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5Vermont Department of Taxes PO Box 547
Montpelier, VT 05601-0547
*1540B1200*
Phone: (802) 828-2551
VT Schedule
Account Application
BR-400B
* 1 5 4 0 B 1 2 0 0 *
Attach to Form BR-400
From Form BR-400, Part 1, Lines 2-4
Business Name ___________________________________________________________________ FEIN _______________________________
Sole Proprietor Name ______________________________________________________________ SSN _______________________________
* If filing for more than one tax type or location, file multiple copies of this form. *
Tax Type - Check ONE
Meals and Rooms (MR)
Sales and Use (SU)
Withholding (WH)
(complete Lines 1-3 and 7-10d)
(complete Lines 1-3 and 7-10d)
(complete Lines 4-10d)
1. Start Date (or Expected Start Date)
2. Estimate of quarterly TAX liability
3. Business Operation
(Lines 1-3 for MR or SU only)
$499 or less
Year Round
Occasional
$500 or more
Seasonal Months of Operation:
____ / ____ / ________
from _______ to _______
mm
dd
yyyy
mm
mm
4. Start Date (or Expected Start Date)
5. Estimate of quarterly TAX liability
6. Federal Withholding
(Lines 4-6 for WH only)
Depositing Requirement
$2,499 or less
Annual
Semi-weekly
____ / ____ / ________
$2,500 - $8,999
Quarterly
Not Yet
mm
dd
yyyy
$9,000 or more - Requires ACH Credit
Established
Monthly
7. Name of Payroll/Filing Service used
No filing
service
8. Your Business Physical Location (Do not enter PO Box)
Same as
Applicant
City
State
ZIP
9. Your Business Mailing Address
Same as
Applicant
City
State
ZIP
10a. Person to contact - Last Name
First Name
10b. Telephone Number
10c. Title
10d. Fax Number
10e. E-mail address
Schedule BR-400B
Rev. 08/15
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