Form Cra - Combined Registration Application For State Of Delaware Business License And/or Withholding Agent - Division Of Revenue Page 5

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REGISTRATION APPLICATION
*DF50515019999*
FOR
STATE OF DELAWARE
DF50515019999
ADDITIONAL BUSINESS LICENSE
DO NOT WRITE OR STAPLE IN THIS AREA
TEMPORARY
F OR R O F F IC E U S E O N LY
THIS FORM MUST BE COMPLETED BY ALL PERSONS OR COMPANIES CONDUCTING BUSINESS ACTIVITIES IN DELAWARE
3-
FAILURE TO COMPLETE ALL QUESTIONS AND/OR REMIT APPLICABLE FEE MAY RESULT IN THE DENIAL OF A BUSINESS LICENSE
1-
2-
1
Enter Employer Identification Number
OR
Social Security Number
TO BE COMPLETED BY TAXPAYERS APPLYING FOR A LICENSE
If you sell tires at retail and/or you sell prepaid wireless telecommunication services at retail in Delaware from this location, you must submit additional license applications.
Trade
2
1
Name
Name
If different
4
3
Physical
Mailing
License
Address
Location
(If Different
Address
from
Physical
License
Location)
City
City
Country
State
Country
State
Zip Code
Zip Code
12-31-
6
5
When did or when will you begin operating in Delaware?
For what calendar year are you applying? Calendar year ending
Describe This License Activity
7
Bus Code
(Must be completed)
8
Check if 65 years or older and whose total sales are less than $10,000 (See Instructions)
9
Total Fee
PLEASE READ INSTRUCTIONS TO COMPLETE BUSINESS CODE AND COMPUTATION OF THE FEE.
MAKE CHECK PAYABLE AND MAIL TO: DELAWARE DIVISION OF REVENUE, P.O. BOX 8750, Wilmington, DE 19899-8750
Important information regarding the term of a business license:
In general, licenses are issued on a calendar year basis. Licenses issued for a new
business shall be for a term of 1 year; expiring on December 31. If the business starts
during the calendar year, the initial license can be prorated according to the month that the
business started. Upon renewal, you will be give the option to renew for 1 year, or 3 years.
If you choose to renew a certain activity for 3 years, then all locations with that same
activity must also be renewed for the 3 year period.
When purchasing a license for an additional location where the existing location is
operating with a 3 year business license, use the same tax year end as the existing license
to prorate the fee for the additional location, so that both licenses will expire on the same
day - keeping the renewal periods aligned.
TITLE
DATE
SIGNATURE
I declare under penalties as provided by law that the information on this application is true, correct and complete.
Rev. 09/15

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