DR-1 
                                                                              Florida Business Tax Application                                                                              R. 01/22 
                                                                                                                                                                                            TC 07/23 
                                                                                                                                                                                            Rule 12A-1.097, F.A.C. 
                                                                                       Register online at 
                                                                                                                                                                                            Effective 01/22 
                                                                                       floridarevenue.com/taxes/registration.                                                               Page 1 of 15
                                                                                       It's fast and secure.

ALL information provided as a part of this application is held confidential by the Florida Department of Revenue. Social security 
numbers are used by the Florida Department of Revenue as unique identifiers for the administration of Florida's taxes. Social security 
numbers obtained for tax administration purposes are confidential under sections 213.053 and 119.071, Florida Statutes, and not 
subject to disclosure as public records. Collection of your social security number is authorized under state and federal law. Visit the 
Department's website at floridarevenue.com/privacy for more information regarding the state and federal law governing the 
collection, use, or release of social security numbers, including authorized exceptions.

                                                                             Use Black or Blue Ink to Complete This Application

Business Information
                                                          1 .  Identification Numbers: 
                                                                   Federal Employer Identification Number (FEIN):
                                                                You must provide your FEIN before you can register for Reemployment Tax. If you are not required by the    
                                                                Internal Revenue Service to obtain an FEIN, you must provide your social security number, unless you are not a 
                                                                citizen of the United States. 
                                                                Social Security Number (SSN):  
                                                               If you are not a citizen of the United States and you do not have a social security number, provide your complete Visa   
                                                               number.  
                 All Applicants -                              Visa Number:  
                                  Identification Numbers       Florida Business Partner Number (if registered):                              
                                                               (business partner numbers are 4 to 7 digits in length) 
                                                               Consolidated Sales and Use Tax Filing Number:  
                                                               (if you file a consolidated sales and use tax return) 
                                                               County Control Number:   
                                                               (if you use this number to report tax for the county where your business is located) 

                                                           .  2 Reason for Applying (select only one): 
                                                                           Business entity not currently registered 
                                                                         Date of first Florida taxable activity:            
                                                                                                               mm dd   yyyy 
                                                                           Additional Florida location for                          Sales and use tax for this location will be reported using my current: 
                                                                       currently registered business                           (select all that apply) 
                                                                       Date of first taxable activity                                                  consolidated return      county control reporting number 
                                                                                                                      mm dd   yyyy 
                                                                           Additional Florida rental property for               Sales and use tax for this location will be reported using my current: 
                                                                       currently registered business                           (select all that apply) 
                                                                       Date of first taxable activity:                                                 consolidated return      county control reporting number 
                                                                                                                       mm dd  yyyy 
                 All Applicants -                                          Moved registered Florida location to                                           Current sales and use tax certificate number for location 
                                  Reason for Applying                      another Florida county -                                                                                         
                                                                           Effective date:                                                     (this number will be cancelled) 
                                                                                                               mm dd  yyyy                    Sales and use tax for this location will be reported using my current 
                                                                                                                                                       (select all that apply) 
                                                                                                                                                                  consolidated return       county control reporting number 
                                                           

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           Starting a new taxable activity at a 
           registered location -                                                          Current sales and use tax certificate number for location 
           Effective date:                                                
                                                        mm dd  yyyy  
           Change the form of business 
           ownership - Effective date:    
                                                        mm dd  yyyy    
           Acquired existing business - 
           Effective date:                       
                                                        mm dd  yyyy  
  .  3 Business Name, Location, and Mailing Address:              Others - Use name filed with the Florida Department of State or
      Sole proprietors - Use last name, first name, middle initial   similar agency in another state 
      Partnerships - Use partnership name or last name of 
      general partners  
      Legal name of business:   
  
      Business trade name "doing business as" if you have one:        
All Applicants - 
Reason for Applying
Physical Address:  Provide the street address of the business location or Florida rental property - Do not use PO Box or 
Rural Route Numbers.
Street address: Florida County: Telephone #: Check if # is outside U.S.

#: ext:
City / State / ZIP:
Fax #:
Mailing Address:  Provide the name and mailing address where tax returns and other correspondence for your business 
are to be mailed.
Mail to: Mailing Address (if different than business location address):

City / State / ZIP:

 4.  Is this business location only open during a portion of a calendar year?                                Yes           No 
      If yes, provide the: 
      First calendar month this business location is open:                      ; and the 
Seasonal  Business       Last calendar month this business location is open:                      . 

   .  5 Form of Business Ownership: (select only one form of ownership) 
             Sole Proprietor (individual owner)                Limited liability company (LLC)                             Estate 
             Partnership (select one below):                    (select one below):                                               Trust 
                     Married couple                                             Single member                                                    Business 
                     General partnership                                     Multi-member                                                      Other 
                     Limited liability partnership (LLP)         If single member,select the box that                   Governmental agency 
                     Limited partnership (LP)                       applies to how your LLC is treated for 
                     Joint venture                                         federal income tax. 
             Corporation (select one below):                           C Corporation 
                     C Corporation                                               S Corporation 
                     S Corporation                                               Disregarded (reported by single member) 
                     Not-for-profit                                         If multi-member, select the box that applies 
                     Foreign corporation                              to how your LLC is treated for federal  
                                                                                  income tax. 
                                                                                          Partnership 
All Applicants - Business Ownership
                                                                                          C Corporation 
                                                                                          S Corporation             

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                                                     6.  If your business is a partnership, corporation, limited liability company, or trust, provide the following information: 
                                                           Date of Florida incorporation or organization, 
                                                          or date of authorization to conduct business at this location in Florida:      
                                                                                                                                                                             mm dd  yyyy 
                                                           Fiscal year ending date (This date is generally "12/31"; however 
                                                          a business may elect a different fiscal year):                                              
                                                                                                                                                                            mm  dd
                                                     7.  If you are a sole proprietor, provide the following information:
                                                   Legal Name (first name, middle initial, last name):                                                                             SSN:

                                                                                                                                                                                  or Visa #:     
     Sole                                          Home address:
                                       Proprietors                                                                                                                                Telephone #:   Check if # is outside U.S.

                                                    City / State / ZIP:
                                                                                                                                                                                  #:             ext:

                                                     8.  If your business is a partnership (including married couples), provide the following information for each general partner: 
                                                          (Attach additional pages, if needed.)
                                                    Name:                                                                                                                         Title:

                                                   Home address:                                                                                                                   SSN:
                                                                                                                                                                                  or Visa #:     
                                                                                                                                                                                  or FEIN:
                                                    City / State / ZIP:                                                                                                           Telephone #:   Check if # is outside U.S.
                                                                                                                                                                                  #:             ext:

                                                    Name:                                                                                                                         Title:

                                                   Home address:                                                                                                                   SSN:
                                                                                                                                                                                  or Visa #:     
                                                                                                                                                                                  or FEIN:
          Business Owners and Managers                                                                                                                                            Telephone #:   Check if # is outside U.S.
                                                    City / State / ZIP:
                                                                                                                                                                                  #:             ext:
                                                    Name:                                                                                                                         Title:

                                                   Home address:                                                                                                                   SSN:
                                                                                                                                                                                  or Visa #:     
                                                                                                                                                                                  or FEIN:
                                                    City / State / ZIP:                                                                                                           Telephone #:   Check if # is outside U.S.
                                                                                                                                                                                  #:             ext:

                                                    Name:                                                                                                                         Title:

                                                   Home address:                                                                                                                   SSN:
                                                                                                                                                                                  or Visa #:     
                                                                                                                                                                                  or FEIN:
                                                    City / State / ZIP:                                                                                                           Telephone #:   Check if # is outside U.S.
                                                                                                                                                                                  #:             ext:

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  9.  If your business is a corporation, limited liability company, or trust, provide the following information for each director, officer, managing 
       member, grantor, personal representative, or trustee of the business entity: 
       (Attach additional pages, if needed.)
 Name: Title:

Home address: Last 4 Digits of Social Security Number:
or Visa #:     
or FEIN:
 City / State / ZIP: Telephone #: Check if # is outside U.S.
#: ext:

 Name: Title:

Home address: Last 4 Digits of Social Security Number:
or Visa #:     
or FEIN:
 City / State / ZIP: Telephone #: Check if # is outside U.S.
#: ext:

 Name: Title:

Home address: Last 4 Digits of Social Security Number:
Business Owners and Managers or Visa #:     
or FEIN:
 City / State / ZIP: Telephone #: Check if # is outside U.S.
#: ext:

 Name: Title:

Home address: Last 4 Digits of Social Security Number:
or Visa #:     
or FEIN:
 City / State / ZIP: Telephone #: Check if # is outside U.S.

#: ext:

  10.  Background: 
         Has your business ever been known                                                   Name: 
          by another name?                                                  Yes             No 
           Was that business issued a Florida certificate                                    Number: 
Applicants - Background            of registration or tax account number?                  Yes            No 
  
  11.  Business Activities:                                                                     Primary code 
         Enter the six-digit North American Industry Classification 
         System (NAICS) code(s) that best describes your 
         business activities at this location. Enter your primary 
         code first. (Enter at least one.) 
  
All Applicants -   
Business Activities          If you do not know your NAICS code(s), go to census.gov/naics. Enter a keyword to 
         search the most recent NAICS list.

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                                                                                         Describe the primary nature of your business and type(s) of products or services to be sold.

                 All Applicants - 
                                                                    Business Activities

                                                                                         12.  Change in Form of Business Ownership or Acquired Business 
                                                                                                If your form of business ownership has changed (e.g., sole proprietorship to a corporation or partnership to a limited liability 
                                                                                                company), or you acquired an existing business, provide the following for your prior form of ownership or for the 
                                                                                                acquired business:
                                                                                           Name:                                                                                 FEIN:

                                                                                           Address:                                                                              Florida certificate or tax account number:

                                                                                           City / State / ZIP:                                                                   If acquired, portion acquired: 
                                                                                                                                                                                          All              Part              Unknown
                                                                                           Did your business share any common ownership, management, or   Did the previous legal entity or acquired business have employees 
                                                                                           control with the acquired business at the time of acquisition? at the time of the change or acquisition? 
                                                                                                                      Yes              No                                          Yes              No

                                                                                           Were employees transferred to the new legal entity or new      Date transferred:
                                                                                           business?         
                                                                                                                     Yes              No                       
                                  Business Changes and Acquisitions                                                                                          mm  dd  yyyy

                                                                                          You must also submit a completed Report to Determine Succession and Application for Transfer of Experience Rating Records 
                                                                                          (Form RTS-1S) within 90 days after the date of transfer when: 
                                                                                                 You acquired an existing business in whole or in part, and 
                                                                                                 There was no common ownership, management or control between your business and the acquired business at the time of transfer.

Sales and Use Tax
                                                                                         13.  For each of the business activities below, select all that apply to this location:  
                                                                                         
                                                                                                Sales, Rentals, or Repairs of Products 
                                                                                                        Sell products at retail (to consumers) 
                                                                                                   Sell products at wholesale (to registered dealers who will sell to consumers) 
                                                                                                Sell products or goods from nonpermanent locations (such as flea markets or craft shows) 
                                                                                                Sell products or goods by mail using catalogs or the internet 
                                                                                                Sell, serve, or prepare food products or drinks for immediate consumption on your premises, or that you package or    
                                                                                                   wrap for take-out or to go, from a temporary or permanent location 
                                                                                                Repair or alter consumer products or equipment 
                                                                                                Rent equipment or other property or goods to individuals or businesses 
                                                                                                Charge admissions or membership fees 
                                                                                           
                                                                                            Property Rentals, Leases, or Licenses 
                                                                                                Rent or lease commercial real property to individuals or businesses 
                                  Sales and Use Tax                                             Manage commercial real property for individuals or businesses 
                                                                                                Rent or lease living or sleeping accommodations to others for periods of six months or less 
                                                                                                   Manage the rental or leasing of living or sleeping accommodations belonging to others 
                                                                                                   Rent or lease parking or storage spaces for motor vehicles in parking lots or garages 
                                                                                                   Rent or lease docking or storage spaces for boats in boat docks or marinas 
                                                                                                   Rent or lease tie-down or storage spaces for aircraft at airports

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Sales and Use Tax (continued)
                         Real Property Contractors 
                                Improve real property as a contractor 
                                Sell products at retail (to consumers) 
                                Construct, assemble, or fabricate building components at your plant or shop away from a project site that are used in 
                                your real property improvement projects 
                                Purchase products or supplies from vendors located outside Florida for use in Florida real property improvement 
                                projects 
                         Services 
                                           Pest control services for nonresidential buildings 
                                           Interior cleaning services for nonresidential buildings 
                                           Detective services 
                                           Protection services 
                                           Security alarm system monitoring services 
                         Fuel 
                                  Sell tax paid gasoline, diesel fuel, or aviation fuel to retail dealers or end users in Florida (select all that apply below): 
                                   Gas station only 
                                   Gas station and convenience store 
                                   Truck stop 
                                   Marine fueling 
                                   Aircraft fueling 
                                   Reseller of fuel in bulk quantities 
                                  Purchase dyed diesel fuel for off-road purposes 
                         Secondhand Goods or Scrap Metal 
                                  Purchase, consign, trade, or sell secondhand goods 
                                  Purchase, gather, obtain, or sell salvage or scrap metal to be recycled or convert ferrous or nonferrous metals into raw 
                                   material products 
                         If you select either of these activities, you must also submit a Registration Application for Secondhand  
Sales and Use Tax        Dealers and Secondary Metals Recyclers (Form DR-1S). 
                           
                         Coin-Operated Amusement Machines 
                             Place and operate coin-operated amusement machines at locations belonging to others 
                                  Operate coin-operated amusement machines at this location (select all that apply below): 
                                   Self-operate some or all the amusement machines at this location (no other machine operator used) 
                                   Have entered into a written agreement with the following person or business to operate some or all the 
                                            machines at this location.
                          Name:                                                                       Telephone #:                Check if # is outside U.S.

                                                                                                      #:                                  ext:

                          Mailing address:

                          City / State / ZIP:

                         If you operate amusement machines at your location or at locations belonging to others, you must also submit an Application for 
                         Amusement Machine Certificate (Form DR-18) to obtain an annual Amusement Machine Certificate for each location where you 
                         operate amusement machines. 
                         Vending Machines 
                         (select all that apply below) 
                                 Place and operate vending machines at locations belonging to others: 
                                 (Select the type or types of vending machines you operate.) 
                                  Food or beverage vending machines 
                                  Nonfood or nonbeverage vending machines 
                                 Operate vending machines at this location: 
                                 (Select the type or types of vending machines you operate.) 
                                  Food or beverage vending machines 
                                  Nonfood or nonbeverage vending machines

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Sales and Use Tax (continued)
                                                                             Purchases 
                                                                                     Purchase items to use in my business without paying Florida sales tax to the seller at the time of purchase (such     
                                                                                     as from a seller located outside Florida) 
                                                                                     Applying for a direct pay permit to self-accrue and remit use tax directly to the Department 
                                                                                     To apply for a permit, submit an Application for Self-Accrual Authority/Direct Pay Permit Sales and Use Tax 
                                                                                     (Form DR-16A). 
                                                                                     Applying for authority to remit sales tax to the Department for independent sellers or distributors (see Rule 
                                                                                     12A-1.0911, Florida Administrative Code, for more information) 
                                  Sales and Use Tax                            
                                                                                     This business does not conduct activities at this location subject to Florida sales and use tax 
                                                                              
Prepaid Wireless Fee
                                                                      14.  Do you sell prepaid phones, phone cards, or calling arrangements at this location?                                     Yes         No 
                                                                                  If yes, select the box that describes your sales:  
                                                                                           Domestic or international long distance calling or phone cards (non-wireless)  
                 Prepaid                                                                       Prepaid wireless services (cards, plans, devices) that provide access to wireless networks and interaction with 
                                                    Wireless Fee                               911 emergency services  

Solid Waste - New Tire Fee, Lead-Acid Battery Fee, and Rental Car Surcharge
                                                                       15.   Do you sell (at retail) new tires for motorized vehicles at this location that are sold separately or as         Yes         No 
                                                                               part of a vehicle? 
                                                                        16.  Do you sell (at retail) new or remanufactured lead-acid batteries at this location that are sold separately 
                                                                               or as a component part of another product such as new automobiles, golf carts, or boats?                       Yes         No 
                                                                        17.  Do you operate a car-sharing service, a peer-to-peer car sharing program, or motor vehicle rental 
                 Solid Waste Fees                   and Surcharge              company at this location that provides motor vehicles that transport fewer than nine passengers?            Yes         No         

Gross Receipts Tax on Dry-cleaning
                                                           18.  Do you own or operate a dry-cleaning plant or dry drop-off facility in Florida?                                            Yes         No 
                                                                  If yes, and you import or produce perchloroethylene or other dry-cleaning solvents, you must also complete a 
                                                    Tax                Registration Package (GT-400401) for fuels and pollutants.
                 Dry-Cleaning 

Reemployment Tax
                                                            For purposes of reemployment tax, employees include officers of a corporation and members of a limited liability 
                                                            company classified as a corporation for federal tax purposes who perform services for the corporation or limited liability 
                                                            company and receive payment for such services (salary or distributions). 
                                                             In addition to registering for Reemployment Tax: 
                                                                                    New Florida employers must register with the Florida New Hire Reporting Center to report newly hired and re-hired 
                                                                                        employees in Florida at servicesforemployers.floridarevenue.com. 
                                                                                    Florida employers are required to obtain appropriate workers' compensation insurance coverage for their employees. 
                                                                                     Visit www.myfloridacfo.com/division/wc/. 
                                                                    19.  Do you have or will you have, employees in Florida?                                                                                            Yes           No 
                                                                    20.  Do you, or will you, lease workers from an employee leasing company to work in Florida?                                  Yes          No         
                                  Reemployment Tax                          If yes, provide the following: 
                                                                           Name of leasing company:

                                                                           FEIN:                                                                              Department of Business and Professional Regulation license number:

                                                                          Portion of workforce that is leased:                                                Date of leasing agreement for workers in Florida:
                                                                                                                                            All           Part
                                                                                                                                                               
                                                                                                                                                              mm  dd   yyyy

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Reemployment Tax (continued)
                                       21. Do you use the services of persons in Florida whom you consider to be self-employed, independent contractors other 
                                             than those engaged in a distinct business, occupation, or profession that serves the general public (e.g., plumber, 
                                             general contractor, or certified public accountant)?                                                                                                                       Yes          No 
                                  
                                                            If yes, you must also submit a completed Independent Contractor Analysis (Form RTS-6061).

                                                        If you answered No to questions 19, 20, and 21, proceed to the Communications Services Tax section. 
                                                                                                If you answered Yes, continue to the next question. 
                                       22. Is your business registered for reemployment tax?                                                                                                                        Yes          No 
                                             If yes, provide your RT account number: 
                                             Are you currently reporting wages to the Florida Department of Revenue?                                                                                   Yes          No 
                                             Are you reactivating your reemployment tax account?                                                                                                                   Yes          No 
                                        23. On what date did you, or will you, first have an employee in Florida?    
                                                                                                                                      mm dd   yyyy

                                  24. Employment Type (select only one employment type):

                                                  Regular employer                                                             Domestic employer [employer of      Agricultural (noncitrus) employer 
                                                  Nonprofit organization [must hold a                                          persons performing only domestic    Agricultural (citrus) employer 
                                                  501(c)(3) determination letter from the                                      (household) services (e.g., maid or 
                                                  Internal Revenue Service]                                                    cook)]                              Agricultural crew chief
                                                                                                                               Indian tribe or Tribal unit 
                                                                                                                               Governmental entity

                                       25. Select one category for your employment:  
                Reemployment Tax
                                             Regular, Indian tribe or Tribal unit, or Governmental employer 
                                                  Have you or will you pay gross wages of at least $1,500 within a calendar quarter?                                                                   Yes               No 

                                                   If yes, provide the date you reached or will reach $1,500 gross wages.                                           
                                                                                                                                                                   mm dd   yyyy
                                                  Have you or will you have one or more employees for a day (or portion of a day) during 20 or more 
                                                  weeks in a calendar year?                                                                                                                                                             Yes               No 

                                                              If yes, provide the last day of the 20th week.                                                        
                                                                                                                                                                   mm dd   yyyy
                                                                                                                               
                                             Nonprofit organization 
                                                  Have you or will you employ four or more workers for a day (or portion of a day) during 20 or more                                           Yes               No 
                                                  weeks in a calendar year? 
                                                              If yes, provide the last day of the 20th week.                                                                                       
                                                                                                                                                                   mm dd   yyyy
                                             Domestic employer (Employer whose employees only perform domestic services.) 
                                                  Have you or will you pay gross wages of at least $1,000 within a calendar quarter?                                                                    Yes               No 

                                                              If yes, provide the date you reached or will reach $1,000 gross wages.                                
                                                                                                                                                                   mm dd   yyyy

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Reemployment Tax (continued)
                                               Agricultural (noncitrus, citrus, or crew chief) employer 
                                                 Have you or will you pay gross wages of at least $10,000 within a calendar quarter?                                                 Yes               No 

                                                If yes, provide the date you reached or will reach $10,000 gross wages.                                                       
                                                                                                                                                                             mm dd   yyyy
                                                 Have you or will you have five or more employees for a day (or portion of a day) during 20 or more 
                                                 weeks in a calendar year?                                                                                                                                            Yes               No 

                                                                   If yes, provide the last day of the 20th week.                                                             
                                                                                                                                                                             mm dd   yyyy
                                       26.    List all Florida locations where you have employees. 
                                                (Attach a separate sheet, if needed.)                                                                                        
                                               Address:

                                               City / State / ZIP:                                                                                                           Number of employees:

                                               Principal products or services:                     If services, indicate if: 
                                                                                                        Administrative          Research          Other

                                               Address:

                                               City / State / ZIP:                                                                                                           Number of employees:

                                               Principal products or services:                     If services, indicate if: 
                                                                                                        Administrative          Research          Other
                                            Address:
                Reemployment Tax
                                               City / State / ZIP:                                                                                                           Number of employees:

                                               Principal products or services:                     If services, indicate if: 
                                                                                                        Administrative          Research          Other
                                               Address:

                                               City / State / ZIP:                                                                                                           Number of employees:

                                               Principal products or services:                     If services, indicate if: 
                                                                                                        Administrative          Research          Other

                                      27.    Payroll Agent Information. If you will use a payroll agent (such as an accountant or bookkeeper) or firm that will maintain your payroll 
                                               information, provide the following:
                                               Name of payroll agent or firm:

                                               Mailing address:

                                               City / State / ZIP:

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                                                                                   (continued)                                                                                                                                         
Reemployment Tax 
                                                 28.    Mailing Addresses for Reemployment Tax. To receive correspondence about reemployment tax reporting, tax rates, and benefits     
                                                          paid, select the appropriate mailing address for each type of correspondence below. 
                                                          Reporting Forms and Information                        Tax Rate Information                               Benefits Paid Information  
                                                          Employer's Quarterly Reports, Certifications,          Tax Rate Notices                                        Notice of Benefits Paid 
                                                          Reporting-related Correspondence:                         Related Correspondence:                          Related Correspondence: 
                                                                Business Information (address in the                    Business Information (address                Business Information (address in the                             
                                                                the first section of this application)                            in the first section of this application)         first section of this application) 
                                                                Payroll Agent Information (address                       Payroll Agent Information                           Payroll Agent Information (address 
                                                                in Question 27)                                                          (address in Question 27)            in Question 27) 
                                                                Other (enter below)                                                  Other (enter below)                                    Other (enter below) 

                                                         Other Address for Reporting Forms and Information
                                                           Name:                                                                                                    Telephone #:                                       Ext:

                                                           Mailing address:

                                                           City / State / ZIP:                                                                          Email address:

                                                         Other Address for Tax Rate Information
                Reemployment Tax
                                                           Name:                                                                                                    Telephone #:                                       Ext:

                                                           Mailing address:

                                                           City / State / ZIP:                                                                          Email address:

                                                         Other Address for Benefits Paid Information
                                                           Name:                                                                                                    Telephone #:                                       Ext:

                                                           Mailing address:

                                                           City / State / ZIP:                                                                          Email address:

Communications Services Tax
                                                29.    Do you sell communications services; purchase communications services to integrate into prepaid calling arrangements; 
                                                        or are you applying for a direct pay permit for communications services tax?                                                                           Yes                No 
                                                        If yes, select each service you sell. 
                                              
                                                                  Telephone service (e.g., local, long distance, wireless, or VOIP)                  Video service (e.g., television programming or streaming) 
                                                                   Paging service                                                                                               Direct-to-home satellite service 
                                                                   Facsimile (fax) service (not when providing advertising or                            Pay telephone service 
                                                                   professional services)                                                                                    Purchase services to integrate into prepaid calling arrangements 
                                                                   Reseller (only sales for resale; no sales to retail customers) 
                Communications Services Tax                        Other services; please describe: 
                                              
                                                 30.    Are you applying for a direct pay permit for communications services tax?                                                                              Yes                No 
                                                         If yes, you must also submit an Application for Self-Accrual Authority/Direct Pay Permit (Form DR-700030).

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Communications Services Tax (continued)
                                                                                                    If you answered No to questions 29 and 30, proceed to the Documentary Stamp Tax section. 
                                                                                                                                           If you answered Yes, continue. 
                                                                                                                     If you are a reseller only, sell only pay telephone or direct-to-home satellite services, or 
                                                                                                                     only purchase services to integrate into prepaid calling arrangements, go to question 34. 
                                                                              31.    To charge the correct amount of tax, you must know the taxing jurisdiction (county and municipality) in which your customers 
                                                                                      are located. How will you verify the assignment of customer location to the correct taxing jurisdictions? If you use multiple  
                                                                                      methods, select all that apply. 
                                                                                               An electronic database provided by the Department of Revenue 
                                                                                              Your own database that will be certified by the Department of Revenue 
                                                                                             To apply for certification, you must submit an Application for Certification of Communications Services                                                                                                            
                                                                                                            Database (Form DR-700012). 
                                                                                              A database supplied by a vendor. Provide the name of the vendor and product:   
                                                                                                             Vendor:                                                                            Product: 

                                                                                              ZIP + 4 and a methodology for assignment when the ZIP codes overlap jurisdictions 
                                                                                              ZIP + 4 that does not overlap jurisdictions (e.g., a hotel located in one jurisdiction) 
                                                                                              None of the above. 
                                                                                       The method you use to verify the assignment of a customer location to the correct taxing jurisdictions (county and municipality) for purposes 
                                       Communications Services Tax                     of collecting local communications services tax determines the collection allowance rate that will be assigned to your business. If you change 
                                                                                       your method of assigning a customer's location to the correct taxing jurisdictions, you must submit a Notification of Method Employed to  
                                                                                       Determine Taxing Jurisdiction (Form DR-700020) indicating the new method(s). For more information, visit floridarevenue.com/taxes/cst. 
                                                                              32.    If you use multiple assignment methods, you may need to file two separate returns to maximize your collection allowances. If you will file  
                                                                                      separate returns for each assignment method, check the box below.  
                                                                                              I will file two separate communications services tax returns, one for each type of assignment method. 
                                                                             33.    Name and contact information of the person who can answer questions about communications services tax returns filed with the Department: 
                                                                         
                                                                                 Name:                                                                                                                   Telephone #:  Ext:

                                                                                Email address:

Documentary Stamp Tax
                                                                             34.     Do you enter into written obligations to pay money with customers at this location that are not recorded with the           
                                                                                       Clerk of the Court or County Comptroller (e.g., financing agreements, title loans, pay-day loans, liens, promissory      
                                                                                       notes, or similar documents)?                                                                                                                                                     Yes               No 
                                                                                       If yes, do you anticipate executing five or more written obligations to pay money subject to documentary 
            Documentary                                            Stamp Tax                  stamp tax per month?                                                                                                                                                                  Yes               No 

Gross Receipts Tax on Electrical Power and Gas
                                                                                    35.     Do you own or operate an electric or natural or manufactured gas (LP gas is excluded) utility distribution 
                                                                                              facility in Florida?                                                                                                                                                                        Yes               No 
                                                                                              If yes, select the type of utility facility: 
                                                                                                                    Electric                  Natural or manufactured gas 
                                                                   Tax
                                                                             36.   Do you import natural or manufactured gas (LP gas is excluded) into Florida for your own use?                                               Yes              No  
                                                                       
                        Gross Receipts 

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Severance Taxes and Miami-Dade County Lake Belt Fees
                                           37.   Do you extract oil, gas, sulfur, solid minerals, phosphate rock, lime rock, sand, or heavy minerals from the  
                                                 soils or waters of Florida?                                                                                                                                                    Yes               No 
                                                 If yes, select each extraction activity that you will engage in: 
                                                  Extracting oil for sale, transport, storage, profit, or commercial use 
                                                  Extracting gas for sale, transport, profit, or commercial use 
Severance Taxes                                   Extracting sulfur for sale, transport, storage, profit, or commercial use 
                                                  Extracting solid minerals, phosphate rock, or heavy minerals from the soil or water for commercial use 
                                                  Extracting lime rock or sand from within the Miami-Dade County Lake Belt Area (see section 373.4149, Florida Statutes, for   
                                                            boundary description)

Enrollment to File and Pay Tax Electronically
                                Filing and paying electronically is quick, easy, and secure at floridarevenue.com/taxes/eservices. You can electronically file and pay most 
                                taxes, fees and surcharges. 
                                  
                                Marketplace providers and persons making a substantial number of remote sales (total of taxable remote sales in the previous calendar year 
                                exceeds $100,000) must file and remit tax electronically. 

                                You may choose to enroll to file or pay tax electronically. Enrolling allows you to view your payment history, reprint your payment information, 
                                and view bills posted to your account. Your bank account and contact information are saved for future transactions. 
                                If you enroll using this application, you will receive a user ID and password for each tax account created based on the information you 
                                provide. Each account will have the same contact, banking, and payment method. After you receive your user ID and password, you may log 
                                into each tax account and change the contact, banking, and method of payment information. 

                                                                      If you choose not to file returns or pay tax electronically, proceed to the 
                                                                                     Authorization for Email Communication section.

                                            38.    Do you wish to: (select only one) 
                                                   Enroll for both filing returns and paying tax electronically? 
                                                   Enroll only to pay tax electronically? 
                                                   File returns and pay tax electronically without enrolling? 
                                                 
                                  39.   If you are enrolling, select only one electronic payment method.     
                               
                                                     ACH-Debit (e-check) – The Department's bank withdraws a payment from your bank account when you authorize the payment. 
                               
File and Pay Electronically                          ACH-Credit – Your bank transfers a payment to the Department's bank account when you authorize the bank to make the 
                                                       payment. This is not a credit card payment. You are responsible for any costs charged by your bank to use this payment  
                                                       method. 
                               
                                   40.           Contact Person for Electronic Payments:
                                                  Name:                                                             Telephone #:   Ext:                        Fax #:

                                                  Mailing address:

                                                  City / State / ZIP:                                               Email address:

                                                             A company employee          A non-related tax preparer Federal Preparer Tax Identification Number (PTIN):
                                                            Payroll agent

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Enrollment to File and Pay Tax Electronically (continued)
                                   41.   Contact Person for Electronic Return Filing (If different than contact person for electronic payments.)
                                         Name:                                                             Telephone #:          Ext:           Fax #:

                                         Mailing address:

                                         City / State / ZIP:                                                Email address:

                                                    A company employee          A non-related tax preparer  Federal Preparer Tax Identification Number (PTIN):
                                                    Payroll agent

                                   42.   Banking Information (not required for ACH-Credit payment method):  
                                         Bank / financial institution name:                                  Account type:            Business                Checking 
                                                                                                                                               Personal                Savings
                                         Bank account number:                                               Bank Routing Number: 
                                                                                                                                                    |:                           :|

                                         Note: Due to federal security requirements, we cannot process international ACH transactions. If any funding for payments comes from 
                                           financial institutions located outside the US or its territories, please contact us to make other payment arrangements. If you are unsure, please 
                                           contact your financial institution. 
                                 
                                  43.    Enrollee Authorization and Agreement: 
                                        This is an Agreement between the Florida Department of Revenue, hereinafter "the Department," and the business entity named herein, 
                                        hereinafter "the Enrollee," entered into according to the provisions of the Florida Statutes and the Florida Administrative Code. 
                                    
                                        By completing this agreement and submitting this enrollment request, the Enrollee applies and is hereby authorized by the Department 
                                        to file tax returns and reports, make tax and fee payments, and transmit remittances to the Department electronically. This agreement 
                                        represents the entire understanding of the parties in relation to the electronic filing of returns, reports, and remittances. 
File and Pay Electronically         
                                       The same statute and rule sections that pertain to all paper documents filed or payments made by the Enrollee also govern an 
                                       electronic return, or payment initiated electronically according to this agreement. 
                                    
                                       I certify that I am authorized to sign on behalf of the business entity identified herein, and that all information provided in this section 
                                       has been personally reviewed by me and the facts stated in it are true. According to the payment method selected above, I hereby 
                                       authorize the Department to present debit entries into the bank account referenced above at the depository designated herein 
                                       (ACH-Debit), or I am authorized to register for the ACH-Credit payment privilege and accept all responsibility for the filing of payments 
                                       through the ACH-Credit method. 
                                    
                                     Printed name:
                                    
                                        Signature: ___________________________________  Title:                                                  Date:
                                    
                                     Printed name:
                                    
                                         Signature: ___________________________________ Title:                                                                                     Date:
                                        (If account requires two signatures) 
                                   

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Authorization for Email Communication
                                                       Your privacy is important to the Department of Revenue. The Department will mail information regarding this application to you. If you wish to 
                                                       receive the information in an email, a written request from you is required. This request allows the Department to send information using its  
                                                       secure email software. This software requires additional steps before you can access the information. 

                                                                                Complete this section to receive information about this application by secure email.

                                                                    I authorize the Department to send information regarding this Application                                    using the Florida Department 
                                                                      of Revenue's secure email. I understand that this method requires additional steps to view the information provided. 
                                                        Provide the name and contact information of the person who can respond to questions about this Application.
                                                       Name:                                                                                                                     Telephone #:        Check if # is outside U.S.
                   Email Communication
                                                                                                                                                                                 #:                           ext:

                                                       Email address:

Applicant Declaration and Signature
                                                       I understand that any person who is required to collect, truthfully account for, and pay any tax, fee, or surcharge, and willfully fails to do so, or any  
                                                       officer or director of a corporation who directs any employee of the corporation to do so, is personally liable for the tax, fee, or surcharge evaded, 
                                                       not accounted for, or paid to the Florida Department of Revenue, plus a penalty equal to twice the amount of the tax, fee, or surcharge due that is 
                                                       evaded, not accounted for, or paid. (Section 213.29, Florida Statutes.) 
                                                       I understand that, in addition to any other civil penalties provided by law, it is a criminal offense to fail or refuse to collect a required tax, fee, or 
                                                       surcharge; to fail to timely file a tax, fee, or surcharge return; to underreport a tax, fee, or surcharge liability on a return; or to give a worthless check, 
                                                       draft, debit card order, or other order on a bank to transfer funds to the Florida Department of Revenue. 
                                                       I understand that I must notify the Florida Department of Revenue of any change in the form of ownership of this business or a change in business 
                                                       activities, location, mailing address, or contact information for this business. 
                                                       I certify that I am authorized by _________________________________ (Officer/Director) to execute this application. I understand that I 
                                                       will be creating a tax account that may result in the responsibility to file returns and to pay a tax, surtax, fee, or surcharge to the Florida 
                                                       Department of Revenue. 

                                                       Under penalties of perjury, I declare that I have read the foregoing Application and that the facts stated in it are true. 
                                                         
                   Applicant Declaration and Signature   
                                                          Printed name:                                                                                              Title:
                                                         
                                                       Signature:________________________________________________________                                            Date:

                                                                                    Before you submit your completed application 

                                                                   Have you:                                                                                    Mail to: Account Management MS 1-5730 
                                                                   Provided your business identification numbers?                                              Florida Department of Revenue 
                                                                   Completed all sections of this application?                                                         5050 W Tennessee St 
                                                                   Signed and dated this application?                                                                    Tallahassee FL 32399-0160
                                                                   Included all additional applications, if required?

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                                                            Contact Us

You may also bring your completed application to your               To speak with a Department representative, call Taxpayer Services at  
nearest taxpayer service center. To find a taxpayer service         850-488-6800, Monday through Friday, excluding holidays. 
center near you, visit floridarevenue.com/taxes/servicecenters. 
                                                                    Subscribe to Receive Updates by Email 
Information, forms, and tutorials are available on the Department's Visit floridarevenue.com/dor/subscribe to sign up to receive an email  
website at floridarevenue.com.                                      when the Department posts: 
  
For written replies to tax questions, write to:                         •  Tax Information Publications (TIPs) 
       Taxpayer Services MS 3-2000                                      •  Proposed rules, including notices of rule development workshops 
         Florida Department of Revenue                                     and emergency rulemaking 
         5050 W Tennessee St                                            •  Due date reminders for reemployment tax and sales and use tax
         Tallahassee FL 32399-0112

                                                            References 
    The following documents were mentioned in this form and are incorporated by reference in the rules indicated below.  
                                  The forms are available online at floridarevenue.com/forms. 
    
           Form RTS-1S         Report to Determine Succession and Application For Transfer of Rule 73B-10.037, F.A.C. 
                               Experience Rating Records 
           Form DR-1S          Registration Application for Secondhand Dealers and Secondary  Rule 12A-17.005, F.A.C. 
                               Metals Recyclers 
           Form DR-18          Application for Amusement Machine Certificate                  Rule 12A-1.097, F.A.C. 
           Form DR-16A         Application for Self-Accrual Authority/Direct Pay Permit Sales Rule 12A-1.097, F.A.C. 
                               and Use Tax 
             
           GT-400401           Registration Package for Motor Fuel and/or Pollutants, 
                               includes the following forms: 
           Form DR-156         Florida Fuel or Pollutants Tax Application                     Rule 12B-5.150, F.A.C. 
           Form DR-600         Enrollment and Authorization for e-Services                    Rule 12-24.011, F.A.C. 
           Form DR-157W        Bond Worksheet Instructions                                    Rule 12B-5.150, F.A.C. 
           Form DR-157         Fuel or Pollutants Tax Surety Bond                             Rule 12B-5.150, F.A.C. 
           Form DR-157A        Assignment of Time Deposit                                     Rule 12B-5.150, F.A.C. 
           Form DR-157B        Fuel or Pollutants Tax Cash Bond                               Rule 12B-5.150, F.A.C. 

           Form RTS-6061       Independent Contractor Analysis                                Rule 73B-10.037, F.A.C. 
           Form DR-700030      Application for Self-Accrual Authority/Direct Pay Permit       Rule 12A-19.100, F.A.C. 
           Form DR-700012      Application for Certification of Communications Services Database  Rule 12A-19.100, F.A.C. 
           Form DR-700020      Notification of Method Employed to Determine Taxing Jurisdiction  Rule 12A-19.100, F.A.C.