Arizona Form 10759 - Transaction Privilege Tax Application (Short Form)
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1
2Arizona Department of Revenue
Arizona Department of Revenue
To Register, File and
Transaction Privilege Tax Application (Short Form)
Transaction Privilege Tax Application (Short Form)
Pay online, go to
License Compliance Unit: 1600 W. Monroe, Ste. 620 Phoenix, AZ 85007
License Compliance Unit: 1600 W. Monroe, Ste. 620 Phoenix, AZ 85007
The simplifi ed application is used for transient vendors. Each section below must be completed, to receive the License.
For licensing questions on transaction privilege or withholding taxes, call (602) 716-6640 or (602) 716-6438. Please return
the completed application with appropriate fees to: License Compliance Unit, Arizona Department of Revenue, 1600 W.
1600 W.
Monroe, Ste. 620 Phoenix, AZ 85007
Monroe, Ste. 620 Phoenix, AZ 85007
Incomplete applications will not be processed. All required information is designated with asterisk *
Business Information
Business Information
Do you have Arizona employees?
Type of ownership
*
(Check One)
Yes
No
(Check One)
Individual
Partnership
Corporation (
)
State and Date of Incorporation
Legal business name
Social Security Number or FEIN
*
*
Business (or DBA) name
Business Start Date
*
*
Business phone (Include area code)
Location and Date of events / swap meets
*
E-mail address
Mailing address (street, route, or PO Box)
City
State
Zip Code
*
Primary Location of Business (Physical address)
City
State
Zip Code
No license will be issued without this information
*
Is your business located on an Indian Reservation?
Yes
No
If yes, please tell us which one
Description of Business
*
Owners / Partnerships / Corporation Offi cers Identifi cation
Owners / Partnerships / Corporation Offi cers Identifi cation
Social security number
Name
Title
% Owned
Complete residence address
Area code & phone number
*
*
*
*
*
*
Please check the months in which you intend to do business in Arizona
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Taxpayer’s Signature
Date
*
License Fees
License Fees
Make Checks Payable to the Arizona Department of Revenue
Make Checks Payable to the Arizona Department of Revenue
State fees $12 X No. Loc.
State fees $12 X No. Loc.
Do Not Send Cash
Do Not Send Cash
Total city fees
Total city fees
City codes for cities where you will be doing business
City codes for cities where you will be doing business
(See reverse side for list of cities for which taxes are collected)
(See reverse side for list of cities for which taxes are collected)
Total fees due
Total fees due
ADOR 10759 (9/11)
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Parent category: Financial