Ador 10759 Arizona Form – Fill Out and Use This PDF

Business Information

Do you have Arizona employees?

Type of ownership *

(Check One)

Yes q

No q

(Check One) q Individual q Partnership q Corporation (State and Date of Incorporation):

Legal business name *

Social Security Number or FEIN *

Mailing address (street, route, or PO Box) *

City

State

Zip Code

Primary Location of Business (Physical address) No license will be issued without this information *

City

State

Zip Code

Is your business located on an Indian Reservation?

Yes q

No

q

If yes, please tell us which one

Description of Business *

(

)

(

)

Please check the months in which you intend to do business in Arizona

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Taxpayer’s Signature *

Date

Do you have employees?

Check yes if you employ individuals in the state of Arizona. If you do not have employees or only have immediate family members

who assist you during a special event or at a swap meet, check no.

Type of ownership

Check as applicable. Corporations and partnerships must provide the federal employer identiication number.

Legal business name or

Enter the individual’s and spouse’s name if Individual was selected for ownership type.

owner name

Enter all partner’s names if Partnership was selected for ownership type. Additional owners may be listed on a separate sheet

and

attached.

Enter the organization name owning or controlling the business if Corporation was selected for ownership type.

Business (or DBA) name

Enter the name of the business/DBA (doing business as) name, if the same as legal business name, enter same. Commonly, the

business name is the name by which the public knows your business/company/shop. If you wish correspondence to be sent to a name

other than the owner, enter the name of the department or accountancy irm as “In Care Of” to ensure delivery by the postal service.

Mailing address

Enter mailing address where all correspondence is to be sent. You may elect to use your home address, corporate headquarters, or

accounting irm’s address.

Primary location of business

Enter the street address for the primary location of the business. If you conduct most of your business at various special events or swap

meets throughout the state, you may wish to enter your resident location. Even if your mailing address is a PO Box, you must provide a

physical location. For example if you live in a rural community, your physical location may be the intersection of two roads, interstates, or

milepost marker.

Description of business

Describe the major activity and principal product you manufacture or commodity sold or service performed. Your description of your business

is very important because it determines your sales tax rate and provides a basis for state economic forecasting.

Owners identiication

Enter as many as applicable, attach a separate sheet if additional space is needed. The authority for mandatory requirement for social

security numbers of owners is provided in ARS § 42-1105.

Signature

The application must be signed by either the individual owner or, for partnerships or corporation, two partners or two corporate oficers.

Sales

Withholding

NAICS code

Business code

PRG code