City and County of Broomfield, One DesCombes Drive, Broomfield CO 80020 
     
                 Finance Department, Sales Tax Division                                                                              
                                                                                                 
                                       Sales Tax License Application            
                  
    E-Mail:   salestax@broomfield.org           Web: http://www.broomfield.org/salestax         303-464-5811       FAX  303-410-3802 
                                                      
                        ** Please fill out all sections completely **                                              No license 
                                       Incomplete application will delay license application process               fee required 
 
Business Information 
Business Name ___________________________________________________________________________________ 
 
DBA Name (if different) _____________________________________________________________________________ 
 
Physical Address __________________________________________________________________________________ 
 
City  ________________________________________  State _______________________   Zip  __________________ 

Business Phone (________)_______________________   Business Fax (________)____________________________ 
Business Web Address________________________________ Business E-Mail ________________________________ 

Mailing Information 
Contact Person ______________________________________________________ Phone _______________________ 
Mailing Address _____________________________________________________ City __________________________ 
State _______________________ Zip _____________  Contact E-mail __________________________________________ 

Owner/Officer Information 
Name:_________________________________ Personal Phone/Address _____________________________________ 
Type of Ownership  Individual/Sole Proprietor ______ Partnership ______ LLC ______ Corporation ______ Trust____ 
 
Type of Location   Commercial/Retail _______    Home Based  ______    Peddler _______     Cart/Kiosk  ______ 
 
FEIN or SSN _______________________  Colorado Dept. of Revenue Sales Tax # ___________________________ 

Reporting Frequency Monthly ____ Quarterly ____ Annually ____    Purchased Existing Business Yes ___  No ____ 

New Business in Broomfield Yes ___ No ____       Registered w/ Secretary of State in Colorado  Yes ____ No ____ 

Date you will start business in Broomfield  __________________________ 

Description of business (please detail types of services/products and nature of business) _______________________ 
________________________________________________________________________________________________                                         
I declare under penalty of perjury, that this application has been examined by me and the statements made herein are made in good faith 
pursuant to Colorado tax laws and regulations, and to the best of my knowledge and belief, are true, correct and complete.   
 
*Late returns will be assessed a $15 per notice penalty fee for the first & second issuance of the 
                                                                                                                   rd        th
delinquency notice. Assessment penalty fees will be $25/notice or 15% of tax due for the 3 , 4  and 
 th         th
5 notices, 6  or more $50 per notice or 30% of tax due For. more information, please visit Broomfield 
Municipal Code 3-04-030 & 3-04-040. Link: https://www.municode.com/library/co/broomfield/codes/municipal_code  
 
SIGNATURE _______________________________________________    DATE ______________________________ 
 
                   For Sales Tax Department only:                                                 
    Account Number Issued:                             Entered by/Date: