Form Cr-17 - Kansas Registration Schedule For Additional Business Locations
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1KANSAS REGISTRATION SCHEDULE
FOR ADDITIONAL BUSINESS LOCATIONS
RCN - FOR OFFICE USE ONLY
EIN: ___ ___ __ ___ ___ ___ ___ ___ ___
Use this schedule to register a business location in addition to the one listed in Part 4 of Form CR-16. Complete this form for each new or
additional location. You must provide the following information for each new or additional location so that your customer profile can be
maintained with the most current information. A new Kansas customer identification number is not required for additional locations; report all
sales for the new or additional location(s) under your current customer identification number.
Check the box for each tax type, license or registration needed for the location listed below.
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Retailers’ Sales Tax
Tire Excise Tax
Liquor Drink Tax
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Retailers’ Compensating Use Tax
Vehicle Rental Excise Tax
Cigarette Vending Machine Permit
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Consumers’ Compensating Use Tax
Dry Cleaning Surcharge
Retail Cigarette/Electronic Cigarette License
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Transient Guest Tax
Liquor Enforcement Tax
Water Protection/Clean Drinking Water Fee
1. Trade Name of Business: _______________________________________________________________________________________
2. Business Location (include apartment, suite, or lot number): ___________________________________________________________
City ____________________________________ County ___________________ State ___________ Zip Code _________________
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3. Is the business located within the city limits?
No
Yes If yes, what city? __________________________________________
4. Describe the primary business activity at this location: _________________________________________________________________
Enter business classification NAICS Code from Pub. KS-1500 (see instructions on page 5): _________________________________
5. Business phone number: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
E-mail: _________________________________________
6. Date location opened under this ownership: _____ _____ _____
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7. Do you ship or deliver merchandise to Kansas customers?
No
Yes
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8. Will sales be made from various temporary locations?
No
Yes
9. If your business is seasonal, list the months you operate: _____________________________________________________________
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10. Is your business engaged in renting or leasing motor vehicles?
No
Yes
Are the leases for more than 28 days?
No
Yes
11. Do you make retail sales of cigarettes and/or electronic cigarettes over-the-counter, by mail, by phone, or over the internet?
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No
Yes If yes, you must enclose with this application, a check or money order for $25.00 for each location and provide your
e-mail or web page address: ____________________________________________________________________________________
If you will sell cigarettes over internet, by phone, or via mail order, provide your e-mail or web page address: ______________________
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12. Will you be the operator of cigarette vending machines?
No
Yes
If yes, you must enclose Form CG-83 and list the
serial number, location addresses, and manufacturer’s brand name of each machine. Also, enclose a check or money order for
$25.00 for each machine.
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13. Is this location a hotel, motel, or bed and breakfast?
No
Yes If yes, number of sleeping rooms available for rent/lease: ______
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14. Do you sell new tires and/or vehicles with new tires?
No
Yes Estimate your monthly tire tax ($.25 per tire): $ ___________
15. If you are a dry cleaner or laundry retailer, do you have satellite locations or agents in businesses not classified as a dry cleaning
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or laundry facility?
No
Yes
If yes, enclose an additional page listing the name, business type, address, city, state and zip
code of each satellite location.
16. If you are registering an additional location for Liquor Drink Tax, enter the date of the first sale of alcoholic beverage at this location:
Month _______ Day _____ Year _______
Check type of license:
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Class “A” Club
Class “B” Club
Caterer
Hotel (Entire premises)
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Hotel/Caterer
Drinking Establishment
Drinking Establishment/Caterer
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17. Are you a public water supplier making retail sales of water delivered through mains, lines, or pipes?
No
Yes
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18. Do you make retail sales of motor vehicle fuels or special fuels?
No
Yes If yes, you must have a Kansas Motor Fuel Retailers
License. The application (MF-53) is available on our web site or office. Complete a separate application for each retail location.
Send this form and any payments to: Kansas Department of Revenue, 915 SW Harrison St., Topeka, KS 66612-1588 or fax to: (785) 291-3614.
For assistance call (785) 368-8222.
CR-17 (Rev. 10/13)
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