List multiple outlets separately in spaces below:
13. If your business is a Texas corporation, enter the charter number and date:
14. If your business is a foreign corporation, enter the following:
15. If your business is a limited partnership, enter the following:
16. List all general partners or principal officers of your business:
Name (First, Middle, Last)
Home Address (street & No., state, zip)
If you purchased an existing business or business assets, complete items 1 thru 4.
If known, enter the former owner’s address and phone:
5. Enter the name and contact number of the person primarily responsible for filing tax returns and any other persons authorized to file taxes on your behalf (the owner is legally responsible for all errors):
The sole owner, all general partners, corporation president, vice-president, secretary or treasurer or an authorized representative must sign this application. Authorized representative must submit a written authority such as a power of attorney with application. (Attach additional signature sheet if necessary) If using a third-party tax preparer, the business owner must sign this application.
By checking the box below, I (We) declare that the information in this document and any attachments are true and correct to the best of my (our) knowledge and belief.
I/We, the undersigned, acknowledge that I/We are fully responsible for compliance with all WORD requirements
and remittance of taxes. The failure of My/Our hired staff or partners does not excuse this responsibility.