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Our Office

PAKISTAN:

1st Floor Suite-108
Al-Hafeez Heights Block D1
Gullberg III, Lahore 54000
+92-300 4344 622

USA:

17W775 Butterfield Rd Suite-123
Oakbrook Terrace, IL 60181
www.hqtax.com
+1 (615) 398-2939

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RESELLER CERTIFICATE

Application Form

State In Which You Are Applying Reseller Certificate *

Business Organization Type *

Legal Name Of Company (As Per Articles Of Organization / Incorporation) *

Nature Of Business *Ecommerce Whole Sale / RetailProfessional ServicesManufacturingReal EstateHealth CareOther

Please Specify *

Federal Employer Identification Number (FEIN)(assigned by the Internal Revenue Services For Reporting Federal Income Taxes)0 / 9

Check Here If you Do Not Have An FEIN

List any Current Or Past 11-digit Taxpayer Number For Reporting Any Taxes Or Fees To The Comptroller Of Public Accounts *0 / 11

Select The State Of USA Where This Company Was Formed *

Home State Registration / File Number *

Company Formation Date *

If This Business Is A Corporation, Has it Been Involved In A Merger Within The Last Seven Years *YesNo

Shareholder Information ( List General Partner, Officer Or Managing Member )

Full Name *

Phone Number *

Home Address *

City *

County (If known) *

State *

Zip Code *

SSN /ITIN *0 / 9

Percentage Of Ownweship *0 / 3

Position Held *General PartnerOffice DirectorManaging MemberOther (Sole Member)

Shareholder Information ( List General Partner, Officer Or Managing Member )

Full Name *

Phone Number *

Home Address *

City *

County (If known) *

State *

Zip Code *

SSN /ITIN *0 / 9

Percentage Of Ownweship *0 / 3

Position Held *General PartnerOffice DirectorManaging MemberOther (Sole Member)

Mailing Address Of Company As Per Articles

Street Number And Name, P.O. Box Or Rural Route And Box Number *

Suite / Apt. Number *

State *

City *

County (If known)

Zip Code *

Mobile / Cellular Phone Number *

Daytime Phone Number *

Fax Number (Area Code And Number)0 / 10

Business Website Address (If Any)

Contact Person For Business Records

Full Name *

Email Address *

Select *Same Address As Mailing AddressI Have My Own Address

Street Address *

Phone Number *

Name Of Bank Or Other Financial Institution *

Select *BusinessPersonal

I Will Be Accepting Payments By Credit Card And / Or Through An Online Payment Processing Company

Merchant Identification Number (MID) Assigned By The Processor

Enter The Name Of The Processor

Legal Name

{text-1}

Is This Place Of Business Operated From Your Home? *YesNo

Do You Ship Or Deliver Items To Cities Or Counties Other Than Where You Have Your Place Of Business? *YesNo

Do You Maintain A Distribution Center, Warehouse, Office Or Any Other Physical Location Where Business Is Conducted? *YesNo

List The Location Of All Distribution Points, Warehouses Or Offices. (Do Not Include Locations That Are Considered A Place Of Business.)

Street *

City *

State

{select-7}

Zip Code *

Do You Have Any Representative, Agent, Salesperson, Canvasser Or Solicitor Who Operates Under Your Authority To Conduct Business At Your Selected Place Of Business, Including Selling, Delivering Or Taking Orders For Taxable Items? *YesNo

Full Name *

City *

Street *

State

{select-7}

Zip Code *

Do You Own, Use, Sell, Lease Or Rent Tangible Personal Property Located At Your Selected Place Of Business? (This Includes Storing Machinery And Equipment) *YesNo

Do You Provide Onsite Taxable Services At Customer Locations At Your Selected Place Of Business? *YesNo

Do You Sell At Temporary Locations (Fairs, Trade Shows, Etc.) At Your Selected Place Of Business? *YesNo

Location And/Or Event Name (E.G., Canton First Mondays, State Fair In Dallas, Etc.) *

Period In Attendance (E.G., First Weekend Of Each Month, Late October, Etc.) *

Do You Have A Franchisee Or Licensee Operating Under Your Name Who Is Required To Collect Sales And Use Taxes? *YesNo

Do You Have A Substantial Ownership In, Or Are Owned In Whole Or Substantial Part, By A Person Who Has A Business Location At Your Selected State For Business And Sells The Same Or Similar Line Of Products Under A Business Name That Is Similar To Your Business Name? *YesNo

Do You Have A Substantial Ownership In, Or Are Owned In Whole Or Substantial Part, By A Person Who Maintains A Location In At Your Selected State For Business To Advertise, Promote Or Facilitate Sales, Deliveries Or Returns Of Your Products? *YesNo

Do You Have Internet Or Mail Order Sales? *YesNo

Are You A Marketplace Provider? *YesNo

Will Your Anticipated Monthly Taxable Sales Exceed $8,000 Per Month? *YesNo

Enter The Date That You Will Begin Making Sales? *

Will You Operate This Business All Year? *YesNo

List The Months You Will Operate: *

Driver's License Number *

Name Of Sole Owner, Partner, Officer, Director Or Member

{name-3}

Are You At Least 18 Yrs Of Age? *YesNo

State *

Upload Signature *

No file chosen

The sole owner, ALL general partners, managing members, officers, directors or an authorized representative must sign. The representative must submit a written power of attorney.

Date Of Signature *

I (We) declare that the information in this document and any attachments is true and correct to the best of my (our) knowledge and belief.

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USA

17W775 Butterfield Rd STE-123
Oakbrook Terrace, Illinois 60181
+18158650761
help@tan-vulture-349726.hostingersite.com

PAKISTAN

108 Al-Hafeez Heights
Gulberg III, Lahore 54000
+923004344622
help@tan-vulture-349726.hostingersite.com

UAE

201-A Millennium Executive
Tower Sheikh Zayed Rd, Dubai
+971586821855
help@tan-vulture-349726.hostingersite.com

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