Form Cr 0100ap - Colorado Sales Tax Withholding Account Application
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6Departmental Use Only
CR 0100AP (10/31/14)
COLORADO DEPARTMENT OF REVENUE
Registration Control Section
PO Box 17087
Denver CO 80217-0087
Colorado Sales Tax
Withholding Account Application
You can now apply online, see page 3 for more information. If applying by paper, read the instructions (on page 4) before completing this form.
A
1. Reason for Filing This Application — Required
Original Application
Change of Ownership
Additional Location
Do you have a Department of Revenue Account Number?
If Yes, Account Number
Yes
No
2. Indicate Type of Organization. If you are not an individual you must have a FEIN number.
Individual
Limited Liability Company (LLC)
Corporation/‘S’ Corp.
Government
General Partnership
Limited Liability Partnership (LLP)
Association
Joint Venture
Limited Partnership
Limited Liability Limited Partnership (LLLP)
Estate/Trust
Non–Profit (Charitable)
1a. Last Name or Business Name
First Name
Middle initial
B
1b. Proof of Identification (Requirements – See page 4)
2a. Trade Name/ Doing Business As (If applicable, and for informational purposes only) 2b. FEIN (required)
2c.SSN
Physical Place of Business
3a. Principal Address (A Colorado address is required if a location in the state)
City
State
Zip
3b. County
3c. If business is within limits of a city, what city? 3d. Phone Number
(
)
Mailing address — enter mailing address here if different than the physical address
4a. Last Name or Business Name
First Name
Middle Initial 4b. Phone Number
(
)
4c. Mailing Address
City
State
Zip
5. List specific products ( you must list the products you sell) and/or services you provide and Explain In Detail
in section 5a. below.
Yes
No
Do you sell alcohol?
Do you rent out items for 30 days or less?
Yes
No
Do you sell tobacco products?
Yes
No
Do you sell Prepaid Wireless?
Yes
No
Is your business in a special taxing district?
Do you sell medical marijuana?
Yes
No
Yes
No
No
Do you rent motor vehicles for 30 days or less?
Yes
Do you sell adult usage marijuana?
Yes
No
5a. List specific products and/or services you provide and Explain In Detail
6a. Owner/Partner/ Corp. Officer Last Name
Owner/Partner/ Corp. Officer First Name
Middle
Initial
6b. Title
6c. FEIN
6d. SSN
6e. Phone Number
(
)
6f. Address
City
State
Zip
7a. Owner/Partner/ Corp. Officer Last Name
Owner/Partner/ Corp. Officer First Name
Middle
Initial
7b. Title
7c. FEIN
7d. SSN
7e. Phone Number
(
)
7f. Address
City
State
Zip
(Form continued on page 2)
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