Form Boe-400-Tpa (S1f) - Trading Partner Agreement For Boe Motor Fuels Electronic Filing Program Page 3

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BOE-400-TPA (S2F) REV. 5 (4-13)

Taxpayer’s security code must be ten (10) alphanumeric characters (any combination of 10 letters and numbers) in length with

no special characters or spaces. Please enter the security code in the spaces provided below. Use upper case for letters.

(Designate the number zero as “Ø”, to distinguish it from the letter “O”.)

15. Contacts: For the purposes of this agreement, the BOE’s contact for the Motor Fuels Electronic Filing Program will be the Appeals and

Data Analysis Section of the Special Taxes and Fees Division.

Following are the names, telephone and FAX numbers, and email addresses of Taxpayer’s c ontacts f or technical information or

questions on transmissions under this program, and for questions regarding the tax information being submitted. Each contact will be

provided a user ID and security code for online access t o the BOE Motor Fuels Electronic Filing System.

TAXPAYER’S EFILING TECHNICAL CONTACT PERSON:

NAME

TELEPHONE NUMBER

FAX NUMBER

EMAIL ADDRESS

(

)

(

)

TAXPAYER’S EXCISE TAX INFORMATION CONTACT PERSON:

NAME

TELEPHONE NUMBER

FAX NUMBER

EMAIL ADDRESS

(

)

(

)

Note: Taxpayers wishing to identify additional contact persons should attach a list containing the information requested above for each

additional contact person.

16. Electronic Return Originator (ERO) Information: The following information is provided to appoint a third-party ERO, if any, to

electronically file Taxpayer’s tax forms and receive all electronically generated messages and acknowledgments concerning the status

of the electronic filing:

ERO NAME

MAILING ADDRESS (city, state, zip code)

17. Changes in the Information Contained in this Agreement: Taxpayer must notify the BOE in writing of any changes in the

information contained in this agreement within thirty (30) days of the change occurring. A change of the Authorized Signer shown in

item 19 requires that a new Trading Partner Agreement be submitted.

18. Certification of Authorized Signer: Under penalty of perjury, I declare that I have examined this agreement and any accompanying

information, and, to the best of my knowledge and belief, it is true, correct, and complete. Taxpayer will comply with all the provisions of

the eFiling Guide and related publications, including fraud prevention and detection guidelines, for all years that Taxpayer participates

in the Motor Fuels Electronic Filing Program. I understand that noncompliance may result in Taxpayer no longer being allowed to

participate in the program. I am authorized to make and sign this statement on behalf of Taxpayer.

19. Authorized Signatures:

A. Taxpayer

NAME OF TAXPAYER

NAME OF TAXPAYER’S AUTHORIZED REPRESENTATIVE AND TITLE (please print)

SIGNATURE OF TAXPAYERS’S AUTHORIZED REPRESENTATIVE (if the authorized representative is not an owner, officer, or employee of the taxpayer, attach a Power of Attorney)

DATE SIGNED

MAILING ADDRESS (city, state, zip code)

TELEPHONE NUMBER

FAX NUMBER

EMAIL ADDRESS

(

)

(

)