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OM B No. 0607-0189: Approval Expires 3/31/2008

FORM SQ-CLA SS(0 0 )

(4-20-2005)

U.S. DEPARTM ENT OF COM M ERCE

Econom ics and Statistics Adm inistration

U.S. CENSUS BUREAU

BU SIN ESS A N D PROFESSION A L CLA SSIFICA TION REPORT

If you have any questions, call w eekdays betw een 8:30 a.m . and 5 p.m ., Eastern tim e on

1 –8 0 0 –2 5 3 –1 8 8 2

Only persons sw orn to uphold the confidentiality of U.S. Census Bureau inform ation m ay see the questionnaires and m ay use them only for statistical purposes. Additionally, all reports are im m une from legal process.

001

NAICS CODE 002

TOC

003

ALPHA

004 XREF

005

BSR KB

STEPS

Census use only

(Please correct any error in nam e, address, and ZIP Code)

IN STRU CTION S – This report covers t his f irm ’s locat ions in t he U nit ed St at es t hat report payroll under t he Federal Em ployer Ident if icat ion N um ber (EIN ) print ed above.

If this EIN has changed, com plete this form for the locations that previously used it to report payroll. If all the locations have been closed or sold, base your answ ers on the last tw o m onths of operation. Use the space in 1 1 to explain these or any other special situations.

1Which of t he f ollow ing best describes t his f irm ’s prim ary business? See attached instruction sheet. M ark (X) one box only.

Retail Trade

Wholesale Trade

Transportation and Warehousing Services

Real Estate and Rental and Leasing Services

Professional, Scientific, and Technical Services

Arts, Entertainm ent, and Recreation Services

Adm inistrative and Support and Waste M anagem ent and Rem ediation Services

Accom m odation and Food Services

Finance and Insurance Services

Inform ation and Data Processing Services

Health Care and Social Assistance Services

Other Services

M anufacturing

Other Area of Business (such as Agriculture, Fishing, M ining, Construction, Forestry, etc.) — Specify

2What is t his f irm ’s t ype of business? Be specific. For exam ple:

Enter "fast food restaurant" rather than "restaurant."

Enter "custom com puter program m ing" rather than "com puter services." For com puter stores, specify one or m ore of the follow ing: end use, for resale, custom assem bly, used, value added reseller.

3	What are t his f irm ’s principal lines of m erchandise sold,		Principal product		Percent of total
	services provided, or product s m anuf act ured, and on		and service lines		sales/receipts
	average, w hat percent of t ot al m ont hly sales/receipt s are

	f rom each of t hese lines?				%
	For exam ple, restaurants that sell only food and alcoholic				%


	beverages should report in the follow ing m anner —
	Food	69%			%


	Alcoholic beverages consum ed on the prem ises	31%			%
					%

4	D oes t his f irm have e-com m erce sales or receipt s?	028
		028	Yes – On average, w hat percent of total monthly	029
		1	Yes – On average, w hat percent of total monthly	%
	E-com m erce includes sales and receipts from any transaction		sales/ receipts are e-commerce sales?	%
	com pleted over an Internet, extranet, EDI netw ork, electronic

	m ail, or other online system . Paym ent for these goods and	2	No
		2	No
	services m ay or m ay not be m ade online.

5What w ere t his f irm ’s t ot al m erchandise sales and/or receipt s f rom services perf orm ed f or t he m ont hs specif ied?

See additional instructions on attached instruction sheet.

•Estim ates are acceptable.

•Include sales from e-com m erce.

M onths	Dollars
006	007
	$
008	009
	$

6Is t his f irm ow ned or cont rolled by anot her com pany?

1 Yes — Enter the nam e, m ailing address, and EIN of the ow ning or controlling com pany.

2 No

010

EIN –

7D oes t his f irm ow n or cont rol any ot her com pany t hat operat es under a dif f erent EIN ?

1		Yes — Enter the nam e, m ailing address, and EIN of
		the ow ned or controlled com pany.
		Continue in 1 1 if m ore than one com pany.
2		No

012

EIN –

CON TIN U E ON REV ERSE SID E

U S C E N S U S B U R E A U

8 How m any locat ions report payroll under t he EIN print ed on t he f ront of t his f orm ?

One location Is t he physical locat ion t he sam e as t he m ailing address print ed on t he f ront of t his f orm ?

Yes — Go to INSTRUCTIONS before 9 .

No — Enter nam e, street address,
city, state and ZIP code
and then go to the Instructions
before	9 .
M ore than one location	Num ber

014

What is t he num ber of locat ions? . . . . . . . . . . . . . . .

Provide t he f ollow ing inf orm at ion f or each of t hese locat ions. If m ore space is required,

continue in	1 1 or on another sheet of paper, using the sam e form at as below .
Store num ber	Nam e and physical location	Description of business
(if any)	(Street address, city, state, and ZIP code)	activities at this location

IN STRU CTION S — If this firm operates in Wholesale Trade — Go to 9 .

If this firm operates in Ret ail Trade — Go to 1 0 .

If this firm operates in Ot her A reas of Business — Go to 1 1 .

9FOR WHOLESA LE FIRM S ON LY

a.Which of t he f ollow ing best describes t his f irm ’s principal t ype of operat ion? See attached instruction sheet. M ark (X) one box only.

Wholesale Distributor (i.e., distributor, jobber, im porter, exporter)

M anufacturers’ sales branch or sales office (selling goods m anufactured, refined, or m ined in t he U nit ed St at es by this firm , this firm ’s parent com pany, or subsidiary)

M anufacturers’ agent, broker, or electronic m arket (buying and selling on a com m ission basis)

b. What w ere t his f irm ’s invent ories at t he end of t he lat est m ont h print ed in 5 or t he lat est period available? Specify date of inventory.

•Estim ates are acceptable.

•Include goods held in transit in the United States, goods held in foreign trade zones in the United States, and goods held by others for sale on consignm ent.

•Exclude goods not for sale (such as fixtures, equipm ent, and supplies), goods ow ned by others and held on consignm ent, and goods held outside the United States.

016Dollars

017Date of inventory

M onthYear

1 0 FOR BOTH WHOLESA LE A N D RETA IL FIRM S a. What is t his f irm ’s prim ary m et hod of selling?

M ark (X) one box only.

019 Store or display show room (selling from a fixed or perm anent location w ith physical displays of priced m erchandise and/or from a counter)

020 Warehouse or office (including telephone/fax/Internet orders or direct business-to-business selling by a sales representative)

021 M ail-order

022 E-com m erce

023

024

025

042

Hom e shopping via television

Direct selling to the general public (selling in a

face-to-face m anner aw ay from a fixed location, such as house-to-house, party plan, or tem porary kiosk sales)

Vending m achines

Other — Specify

b. A s a general business pract ice, does t his f irm sell t o household consum ers and individual users?

1	Yes	On average, w hat percent of t ot al m ont hly sales are t o household	018
1	Yes		%
		consum ers and individual users?	%
2	No

c. D oes t his f irm sell t o ret ailers/w holesalers f or resale?
			030
			030
026 1	Yes	On average, w hat percent of t ot al m ont hly sales w ere f or resale?	%


2	No

d. D oes t his f irm prim arily sell nonconsum er durable goods (such as: indust rial

m achinery, f arm equipm ent , const ruct ion m achinery, heavy t ruck s, and t ract ors)?

0271 Yes

2 No

1 1 A re t here any rem ark s t hat help clarif y your responses?

1 2 Whom should w e cont act if w e have quest ions regarding t his report ?

Nam e — Please print		Telephone

	Area code	Num ber	Extension

Title		FAX
	Area code	Num ber	Extension

em ail address

D ETA CH THE IN STRU CTION SHEET A N D RETU RN THE COM PLETED FORM IN THE EN CLOSED EN V ELOPE.

IF Y OU PREFER, Y OU M A Y FA X THE COM PLETED FORM TO 1 –8 0 0 –4 4 7 –4 6 1 3 .

FORM SQ-CLASS(00) (4-20-2005)

Page 2

Question	Answer
Form Name	Form Sq Class
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	sqclass business and professional classification report form

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