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Form Wisconsin Dept of Revenue
Wisconsin Nexus Unit, MS 2-233
A-816 PO Box 8906
Nexus Questionnaire Madison WI 53708-8906
phone: (608) 266-3969 •FAX: (608) 266-5464 •email: DORNexusUnit@wisconsin.gov • website: revenue.wi.gov
Case ID: - - - (Found on letter received. If submitting voluntarily, leave blank.)

Part A: Business Information
Legal name (sole proprietors enter last, first, mi) Business name (DBA)

Mailing address City State Zip code

FEIN or SSN (required for sole proprietors) Date income year ends (mm/dd) Organization date (mm/dd/yyyy) State of organization

Website(s)

Does this business have a Certificate of Authority to transact business in Wisconsin from the Wisconsin Department of Financial Institutions? Yes No
List all states where business is conducted

List all states where business is filing franchise/income tax returns

Part B: Business Type
1. How is this business organized? (check one)
C Corporation S Corporation Limited Liability Company Partnership
Limited Liability Partnership Sole Proprietor Single Member Limited Liability Company*
Qualified Subchapter S Subsidiary* Non-Profit Organization exempt under IRC Sec.

2. What federal tax form does this business use to report income? (check one)
1120 1120S 1065 1040, Schedule C 990-T
*If a related entity reports the income, list the Legal Name and FEIN/SSN for form checked in question B2:

Part C: Wisconsin Customers and Receipts
When completing this section, include sales delivered, shipped, or sourced to Wisconsin. Sales “in Wisconsin” are determined as follows:
• For sales and use tax purposes, see sec. Tax 11.945, Wis. Adm. Code.
• For income and franchise tax purposes, see sec. Tax 2.39(6), Wis. Adm. Code. For specialized industries, see secs. Tax 2.46 through 2.505,
Wis. Adm. Code.
1. Has this business made sales in Wisconsin or had Wisconsin customers?...................... Yes No
If yes, complete questions 1a through 1e below.
a. What year did this business first sell products or services in Wisconsin?
b. For the current year plus the prior seven years, list the number of transactions in Wisconsin.
20 20 20 20
20 20 20 20
c. For the current year plus the prior seven years, list the number of customers in Wisconsin.
20 20 20 20
20 20 20 20
d. For the current year plus the prior seven years, list the gross sales in Wisconsin.
20 20 20 20
20 20 20 20

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e. For the last full tax year, review your sales “in Wisconsin”. List the three largest customers, and the gross sales in or sourced in Wisconsin:
Wisconsin Customer Receipts
1. 1.
2. 2.
3. 3.

Part D: Business Activities - For the current year plus the prior seven years
1. Has this business sold tangible personal property to customers in Wisconsin?...................... Yes No
If yes,
a. At retail to the end user? .................................................................. Yes No
b. At wholesale for resale?................................................................... Yes No
c. Year(s)?
d. Describe products:

2. Has this business rented or leased tangible personal property to customers in Wisconsin? ........... Yes No
If yes,
a. Year(s)?
b. Describe products:

3. Has this business made deliveries into Wisconsin using a company owned or operated vehicle?....... Yes No
If yes,
a. Year(s)?
b. On return trips, does this business haul products out of Wisconsin? ................................ Yes No
c. Are sales made by the vehicle driver(s)?...................................................... Yes No
4. Has this business shipped products to Wisconsin in returnable containers? ........................ Yes No
If yes,
a. Year(s)?
b. Does this business retain ownership of the containers? .......................................... Yes No
c. Does this business charge a deposit on the containers?.......................................... Yes No
5. Has this business, an affiliated business or third party made online sales of your products to Wisconsin
customers? .............................................................................. Yes No
If yes, list the website(s) from which sales are made:

6. Has this business sold digital goods received by customers in Wisconsin? (Digital goods includes, but
are not limited to, audio works, audiovisual works, books, greeting cards, periodicals, video games,
newspapers, or anything transferred electronically to the purchaser, other than computer software.) ... Yes No
If yes,
a. Year(s)?
b. Describe digital goods:

7. Has this business licensed intangibles for use in Wisconsin, including, but not limited to, software,
trademarks, trade names, patents, copyrights or franchises? ..................................... Yes No
If yes,
a. Year(s)?
b. Describe intangible property:

c. Enclose a copy of any license agreement with customers in Wisconsin.

A-816 (R. 4-23) 2

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Part D:  Business Activities Continued - For the current year plus the prior seven years
  8.  Has this business solicited, advertised or marketed to Wisconsin customers?  . . . . . . . . . . . . . . . . . . . . . . Yes No 
   If yes,
   a.  Year(s)?
   b.  Describe methods: 

  9.  Has this business provided services to real or tangible personal property (e.g., repair, installation, 
   assembly, maintenance, inspection, etc.) in Wisconsin? .........................................                            Yes No 
   If yes,
   a.  Year(s)?
   b.  Describe services:

10.  Has this business provided professional services (e.g., training, consulting, accounting, engineering, 
   real estate, brokerage, etc.) for customers in Wisconsin? ........................................                          Yes No 
   If yes,
   a.  Year(s)?
   b.  Describe services:

11.  Has this business provided any other services (e.g., telecommunications, research, landscaping, 
   testing, etc.) for customers in Wisconsin? .....................................................                            Yes No 
   If yes,
   a.  Year(s)?
   b.  Describe services:

12.  Has this business performed services outside Wisconsin for which the benefits were received in Wisconsin?                 Yes No 
   If yes,
   a.  Year(s)?
   b.  Describe services:

13.  Has this business used or consumed any tangible personal property while performing services for 
   customers in Wisconsin? ...................................................................                                 Yes No 
   If yes,
   a.  Year(s)?
   b.  Was sales tax paid on the purchase of the tangible personal property? ..............................                    Yes No
   c.  Describe property used:

14.  Has this business performed construction activities in Wisconsin? ................................                        Yes No 
   If yes,
   a.  Year(s)?
   b.  Describe activities:

15.  Has this business hired subcontractors to perform services in Wisconsin? .........................                        Yes No 
   If yes,
   a.  Year(s)?
   b.  Describe services:

   c.  Enclose a copy of any contract with a subcontractor(s) to perform services in Wisconsin.

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16.  Are any Wisconsin sales, rentals, or leases exempt from Wisconsin sales or use tax? ................              Yes       No 
   If yes,
   a.  Explain:

   b.  What percentage of Wisconsin sales, rentals or leases are exempt? 

Part E:  Employees, Representatives and Subcontractors - For the current year plus the prior seven years
  1.  Has this business paid salaries, wages, fees or commissions to any persons living in Wisconsin?  . . . . .       Yes       No 
   If yes,
   a.  Year(s)?
   b.  Describe the activities performed:

   c.  Were activities performed in Wisconsin?  .....................................................                  Yes       No
    If no, where were the activities performed?
   d.  Enclose a copy of job descriptions or written agreements with such employees or representatives in Wisconsin. 
  2.  Has this business issued Form 1099-MISC to any individuals or businesses in Wisconsin?  ...........              Yes       No 
   If yes,
   a.  Explain:

   b.  How many per year?
    20                                         20                            20                                      20
    20                                         20                            20                                      20
  3.  Has this business, including its employees, representatives, or agents come into Wisconsin to perform 
   business activities?  .......................................................................                       Yes       No 
   If yes,
   a.  Describe the business activities performed:

   b.  Are any of the following activities performed in Wisconsin:
    •           Accepting or rejecting orders? ............................................................            Yes       No
    •           Making immediate delivery from inventory on hand? ..........................................           Yes       No
    •           Accepting payments or deposits from customers? ............................................            Yes       No
    •           Exchanging or replacing unsuitable merchandise? ............................................           Yes       No
    •           Accepting returned or repossessed merchandise? ............................................            Yes       No
    •           Resolving dealer/customer complaints?  ....................................................            Yes       No
    •           Negotiating, renewing or completing contracts or agreements? ..................................        Yes       No
    •           Collecting delinquent accounts?  ..........................................................            Yes       No
   c.  How many activity days per year? (Example: Ten persons for one day or one person for ten days are both ten activity days.)
    20                                         20                            20                                      20
    20                                         20                            20                                      20
   d.  If activities are performed in Wisconsin by a representative, provide a standard agreement or contract. 
  4.  Has this business, including its employees, representatives, or agents attended or participated in any 
   temporary events in Wisconsin (e.g. trade shows, flea markets, arts and craft shows, career fairs, festivals)?      Yes       No 
   If yes,
   a.  List the number of days per year:
    20                                         20                            20                                      20
    20                                         20                            20                                      20
   b.  Has this business made sales of on-hand products or services at any temporary event in Wisconsin?......         Yes       No

A-816 (R. 4-23)                                                             4

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  5.  Has this business, including its employees, representatives, or agents, conducted seminars or training 
   courses in Wisconsin? .....................................................................                                Yes No 
   If yes,
   a.  Year(s)?
   b.  Describe seminar(s) and/or training course(s): 

Part F:  Locations and Property - For the current year plus the prior seven years
  1.  Has this business or its employee(s) maintained a business location (e.g., home office) in Wisconsin?   .               Yes No 
   If yes,
   a.  Year(s)?
   b.  Provide the location(s) and telephone number(s), number of persons and activities at each location:

  2.  Has this business held loans secured by real or tangible personal property located in Wisconsin?      .....             Yes No 
   If yes,
   a.  Year(s)?
   b.  Describe property:

  3.  Has this business:
   a.  Owned, leased or rented any real or tangible personal property located in Wisconsin? ..................                Yes No
   b.  Stored any tangible personal property in Wisconsin? ............................................                       Yes No
   c.  Owned any goods in a Wisconsin warehouse, on consignment, or in possession of a distributor or other 
      representative in Wisconsin?   ...............................................................                          Yes No
   d.  Had any tangible personal property in possession of a potential customer in Wisconsin? . . . . . . . . . . . . . . . . Yes No
   If yes to any of the above,
   •  Year(s)?
   •  List the type, value, and location of goods or property:

Part G:  Ownership and Related Entities
  1.  Is this business a parent company? ..........................................................                           Yes No
  2.  Is this business a subsidiary? ...............................................................                          Yes No
  3.  Does this business file a federal consolidated return? ...........................................                      Yes No
   a. If yes to Question 2 or 3, provide the parent company’s legal name, FEIN and address:

  4.  Does this business own, directly or indirectly, a general interest in a partnership that does business in  
   Wisconsin, regardless of the percentage of ownership?      .........................................                       Yes No
  5.  Does this business own, directly or indirectly, an interest in a limited liability company that does  
   business in Wisconsin, regardless of the percentage of ownership, and the limited liability company  
   is treated as a partnership for federal tax purposes?  ............................................                        Yes No
  6.  Is this business a shareholder or member of an S corporation or limited liability company that has  
   operations, conducts business or owns real property in Wisconsin?  ..............................                          Yes No
  7.  Does this business have any other affiliated or related entities?  ..................................                   Yes No
  8.  If yes to any questions G4 through G7, provide business information on page 7.

A-816 (R. 4-23)                                                         5

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Part H:  Preparer Information and Signature
By signing below, I declare that the information furnished in this questionnaire and all attachments are true, correct, and complete to the best of my knowledge and belief.
Name (print or type)                        Title

Signature                                   Email address

Telephone number                            Date

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                Business Information for Questions G4 through G7
Legal name                FEIN                                  Relationship

Address                   Description of all business activity in Wisconsin and years

City            State Zip

Legal name                FEIN                                  Relationship

Address                   Description of all business activity in Wisconsin and years

City            State Zip

Legal name                FEIN                                  Relationship

Address                   Description of all business activity in Wisconsin and years

City            State Zip

Legal name                FEIN                                  Relationship

Address                   Description of all business activity in Wisconsin and years

City            State Zip

Legal name                FEIN                                  Relationship

Address                   Description of all business activity in Wisconsin and years

City            State Zip

Legal name                FEIN                                  Relationship

Address                   Description of all business activity in Wisconsin and years

City            State Zip

Legal name                FEIN                                  Relationship

Address                   Description of all business activity in Wisconsin and years

City            State Zip

A-816 (R. 4-23)          7

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