Form 001 - Sales And Use Tax License Application Multi Level Page 2

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*0-0-0-001*
*0-0-0-001*
Wyoming Department of Revenue
Excise Tax Division
122 W. 25th Street, Herschler Bldg.
Department Use Only
Cheyenne, Wyoming 82002-0110
RID:__________________
License:_______________
Fling Freq:_____________
Multi-Level
ALL LINES MUST BE COMPLETED IN ORDER TO PROCESS THIS APPLICATION
1. Ownership Name:_________________________________________________________ (1) ____________________________
(federal identification number)
2. Date of first Sale / Service in Wyoming_______/_________/_______________________(1)____________________________
(
)
date and state of incorporation
3. DBA/Doing Business As Name:_____________________________________________________________________________
4. Please check one of the following that best describes your ownership (spousal ownership is considered a partnership):
A. ________Association/Club
B. ________Corporation
C. ________Individual
D. ________Limited Partnership
E .________Limited Liability Company
F. ________Partnership
G. ________Other (explain)
5. Mailing Address:_______________________________________________________________________________________
Street or PO Box
City
State
Zip Code
6. Location Address:______________________________________________________________________________________
Street
City
State
Zip Code
7. Internet E-Mail Address:________________________________ @___________________________________
8. Business Telephone Number: (
)_______-________ (800)_______-___________Fax No:(
)________-_________
9. Authorized Contact:________________________________________________Phone Number: (
)_______-__________
10. What Type of Sales does this business make? Retail_________Wholesale_________Service________Manufacturer_______
11. Estimated monthly sales volume: $____________________
12. Describe specifically the type of products and/or services this business provides, (ex: auto parts, computers and/or auto repair,
computer repair) give the percentage of each: total must equal 100%
A. _____________________ _____%
B._______________________ ______% C.______________________ _____%
13. Is this business located within the boundaries of an incorporated city or town in Wyoming?
Yes_______ No________
14. Has this ownership ever had a Wyoming Sales/Use Tax License?
Yes_______ No________
15. How many independent sales contactors do you have in Wyoming? ____________
Note:
Original Signature(s) are required for all ownership types. The business owner must sign for the individual ownership, all partners
must sign for partnerships, one major officer for a Corporation, one member or manager a Limited Liability Company and Limited
Partnership. Attach an additional signature page if needed. Signatures must be original.
A.
Print Name:__________________________________
Signature__________________________________________
Address: __________________________________
City:______________________State________Zip_________
SSN:_______________________________________
Title______________________________________________
B. Print Name:__________________________________
Signature__________________________________________
Address: __________________________________
City:______________________State________Zip_________
SSN:_______________________________________
Title______________________________________________
C. Print Name:__________________________________
Signature__________________________________________
Address: __________________________________
City:______________________State________Zip_________
SSN:_______________________________________
Title______________________________________________
Don’t forget! *To complete all lines of this application in its entirety, including all required signatures.
*Include the $60.00 non-refundable application fee.
*Please make check payable to the Wyoming Department of Revenue
*For assistance completing the application please call (307) 777-5200.
ETS Form 001ML Revised: 04/25/2011

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