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AB AP-215
CD (Rev.1-17/9)

Texas Online Sales and Use Tax Registration Signature Form
                                                                                                                   Operating without a valid Texas Sales 
                                                                                                                   and Use Tax Permit is a misdemeanor 
                                                                                                                   punishable by a fine of not more 
                                                                                                                                  than $500 per day.
                                                                                                                   Texas taxpayer number

You registered for a Texas sales and use tax account. You are required to comply with all tax return filing requirements, 
as provided in Rule 3.286, until this account is closed. Your sales and use tax permit will not be issued, however, until we 
have received your signature on this completed form.

Who Must  Sign This Signature Form -        The  sole  proprietor,  all general  partners,  managing  members,  officers,  directors  or  an  authorized 
representative of an entity completing an online registration must sign this signature form attesting to the accuracy of the information submitted 
online.  A representative  must  submit  a written power  of attorney.  Applicants  must  be  18  or older.  Parents/legal  guardians  may  apply  for a 
permit on behalf of a minor.

I (We) declare that the information submitted online and on any attachments is true and correct to the best of my (our) knowledge and belief.

Type or print name and title of sole proprietor, partner, officer, director or member Driver license number  State
                                                                                                            /
                                                                                                                   Date

AB

Type or print name and title of partner, officer, director or member                  Driver license number  State
                                                                                                            /
                                                                                                                   Date

AB

Type or print name and title of partner, officer, director or member                  Driver license number  State
                                                                                                            /
                                                                                                                   Date

AB

WARNING. You may be required to obtain an additional permit or license from the State of Texas or from a local governmental entity to
conduct business. A listing of links relating to acquiring licenses, permits, and registrations from the State of Texas is available online
at http://www.Texas.gov. You may also want to contact the municipality and county in which you will conduct business to determine
any local governmental requirements.

For Assistance - Questions about this form or Texas sales and use tax can be submitted to us at www.comptroller.texas.gov/taxes/, or you can speak 
to one of our specialists at 1-800-252-5555.

                                                                                                            Mail:  Texas Comptroller of Public Accounts
                                                                                                                   111 E. 17th St.
                 Complete and sign this form, and return it                                                        Austin, TX  78774-0100
                 by mail, by FAX or by email.
                                                                                                            FAX:   1-877-882-8890
                                                                                                            Email: sales.applications@cpa.texas.gov
   You have certain rights under Chapters 552 and 559, Government Code, to review, request and correct information we have on file about you. 
                 To request information for review or to request error correction, contact us at the address or phone number listed on this form.