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Form Wisconsin Dept of Revenue
Nexus Unit  2‑233
Affiliate Registration Verification
A-002 PO Box 8906
Madison WI  53708‑8906

phone: • •revenue.wi.gov(608) 266‑3969       FAX:  (608) 266‑5464       website:  

A.  Identification
Legal name (sole proprietors enter your last name, first, MI) Business name (DBA)

Mailing address City State Zip

Federal Employer Identification Number (FEIN) SSN required for sole proprietors Website address

Sole Proprietorship
Corporation  C corp
  S corp Date of incorporation  State of incorporation
(mm dd yyyy)
QSub }
Legal name of owner Owner SSN or, if owner is a business, enter FEIN

Partnership  General Limited (LP)
Limited Liability Partnership (LLP)
Date registered  State of registration
Limited Liability Company (LLC) } (mm dd yyyy)
LLC classification for Corporation Partnership
 federal income tax 
Disregarded entity (LLC activity reported on owner’s income tax return).  Enter owner below.
Legal name of owner Owner SSN or, if owner is a business, enter FEIN

Other (e.g., Governmental unit, nonprofit organization)

If your income year does not end on December 31st, enter the date your fiscal year ends ‑
(mm - dd)

B.  Current Wisconsin Registration Status  (check appropriate box)

Currently registered to collect and remit Wisconsin sales and use tax.  Enter Wisconsin sales and use tax account number.

Registering to collect and remit Wisconsin sales and use tax.  Register online at tap.revenue.wi.gov/btr and enter your 
Business Tax Registration confirmation number.

All sales of products and services in Wisconsin are exempt. Complete and attach Affidavit of Exempt Sales (Form A‑006).

We are not eligible to submit an Affidavit of Exempt Sales and decline to register to collect and remit Wisconsin sales 
and use tax.  (Note:  Wisconsin state agencies and authorities may not purchase products or services from your company).

A-002 (R. 1-17) Go to Page 2 (see back)

C.  Wisconsin Business Activity

 1. Describe all products sold, rented or leased to Wisconsin customers.

 2. Describe all services sold or provided to Wisconsin customers.

 3. Do you sell products or services in Wisconsin to customers that are not governmental units?           Yes No

 4. Are all of your sales in Wisconsin exempt from sales and use tax?                                     Yes No
   Why are all sales exempt?  (check all that apply)
    Sales to governmental units
    Sales for resale
    Sales are not taxable.  Exemption certificates provided by customers or nontaxable services
    Other (describe)

 5. Do salespersons or representatives visit Wisconsin for any business purpose?                          Yes No
   If yes, explain?

 6. Do you license software or intangible assets, such as trademarks, customer lists, etc., in Wisconsin? Yes No

 7. Do you provide services outside Wisconsin for which the benefits are received in Wisconsin?           Yes No

I certify that, to the best of my knowledge, the above information is accurate and complete.

Completed by  (type or print)                                     Title

Signature                                                         Date

(   )
Telephone number                                                  Email address

A-002 (R. 1-17)                                     ‑ 2 ‑