Form Boe-400-Mip - Application For Seller'S Permit And Registration As A Retailer (Individuals/partners) Page 2

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6
BOE-400-MIP (BACK) REV. 14 (5-00)
31.IF ALCOHOLIC BEVERAGES ARE SOLD, PLEASE LIST YOUR ALCOHOLIC BEVERAGE CONTROL LICENSE NO. AND TYPE
32. NAME, ADDRESS & TELEPHONE NUMBER OF ACCOUNTANT/BOOKKEEPER
33. NAME, ADDRESS & TELEPHONE NUMBER OF BUSINESS LANDLORD
34. NAME & LOCATION OF BANK OR OTHER FINANCIAL INSTITUTION (Note whether business or personal)
CHECKING ACCOUNT NUMBER(S)
SAVINGS ACCOUNT NUMBER(S)
35. NAME & ADDRESS OF MAJOR SUPPLIERS
PRODUCTS PURCHASED
SECTION III: SALES AND EMPLOYER INFORMATION
36. PROJECTED MONTHLY SALES
Total gross sales $
Taxable sales $
37. INFORMATION CONCERNING EMPLOYMENT DEVELOPMENT DEPARTMENT (EDD)
Are you registered with EDD? ..........................................................................................................
Yes
No
If no, will your payroll exceed $100 per quarter? ............................................................................
Yes
No
If yes, you must make application with EDD.
(See pamphlet DE 44, California Employer’s Guide )
Number of employees
I have already received pamphlet DE 44, California Employer’s Guide . ........................................
Yes
No
CERTIFICATION
The statements contained herein are hereby certified to be correct to the best knowledge and belief of the
undersigned who is duly authorized to sign this application. (All owners’ and partners’ signatures are required.)
NAME (typed or printed)
TITLE
SIGNATURE
DATE
✍
NAME (typed or printed)
TITLE
SIGNATURE
DATE
✍
FOR BOARD USE ONLY
Furnished to Taxpayer
REPORTING BASIS
PUBLICATIONS
FORMS
PUB 73
PUB DE 44
BOE-8
BOE-400-Y
SECURITY REVIEW
BOE-467
BOE-519
BOE-598-LZ $
BOE-1009
BOE-1241-D
BY
APPROVED BY
REGULATIONS
RETURNS
REMOTE INPUT DATE
REG. 1668
REG. 1698
REG. 1700
BY
Permit Issued Date
Application for Seller’s Permit n Individuals/Partners (5-00)

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