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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: