PDF document

- 1 -

Form Wisconsin Department of Revenue
Nexus Unit 2‑233
PO Box 8906
A-816 Nexus Questionnaire Madison WI 53708‑8906
Phone: (608) 266‑3969
FAX: (608) 266‑5464
website: revenue.wi.gov
A. Company Identification
Legal Name (sole proprietors enter your last name, first, MI) Business Name (DBA)

Mailing Address City State Zip

Federal Employer Identification Number (FEIN) Social Security Number (SSN) if sole proprietor or individual Website Address

1. Does this company’s income tax year end on December 31? .................... No Yes
If no, enter the fiscal year end date
(mo/day)
2. Has this company obtained a Certificate of Authority to transact business in Wisconsin During what year?
from the Wisconsin Department of Financial Institutions (formerly Secretary of State)? No Yes 

B. Business Entity Information
1. Business Type (check appropriate box and provide related information)
Sole Proprietor
Partnership
SC Corporation   StateDate of Incorporation Corporationof Incorporation
(mo/day/yr)
Limited Liability Company  Taxed as a Partnership Taxed as a Corporation
Single Member Limited Liability Company (disregarded as a separate entity)
Name of Single Member FEIN / SSN

Qualified Subchapter S Subsidiary (QSUB)
Name of Parent (S) Corporation FEIN

Exempt Organization  Exempt under what section of the Internal Revenue Code?
• Does this organization have unrelated business income reportable on Federal Form 990‑T? ...... No Yes
Other (describe)

2. What federal income tax form does this company file?

C. Company Activities – Answers should include information for the current year plus the prior seven years .
1. Does this company sell products (tangible personal property) to customers in Wisconsin? .............. No Yes
A. At retail to consumers or users? ......................................................... No Yes
B. At wholesale for resale? ............................................................... No Yes
• If yes, during what years?
• Describe products.

2. Does this company rent or lease products (tangible personal property) to customers in Wisconsin? ....... No Yes
• If yes, during what years?
• Describe property rented or leased.

A‑816 (R. 11‑15)

- 2 -

C. Company Activities (Cont’d.) – Include information for the current year plus the prior seven years.
3. Are all company sales, rentals or leases to customers who furnish an exemption certificate? ............ No Yes
• If yes, explain.

4. Does this company, or any affiliate companies, make online sales? ................................ No Yes
• If yes, list the website(s) from which sales are made.

5. Does this company sell digital goods to customers who receive the product in Wisconsin? Digital goods includes,
but is 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. ....... No Yes
• If yes, during what years?
• Describe digital goods sold

6. Does this company provide services to products (tangible personal property) (e.g. repair, installation,
maintenance, inspection, etc.), professional services (e.g., training, consulting, accounting, engineering,
etc.) or other services (e.g. landscaping, telecommunications, etc.) to customers in Wisconsin? ........ No Yes
• If yes, during what years?
• Describe services

7. Are all company sales of services to customers who furnish an exemption certificate? ................. No Yes
• If yes, explain.

8. Does this company perform construction activities in Wisconsin? ................................. No Yes
• If yes, during what years?

9. Does this company hire subcontractors to perform any services in Wisconsin? ...................... No Yes
• If yes, during what years?
• Describe services

10. Has this company sold real estate in Wisconsin? .............................................. No Yes
• If yes, during what years?

11. Has this company distributed free samples of its products in Wisconsin? ........................... No Yes
• If yes, during what years?

12. Has this company used any tangible personal property in Wisconsin on which no sales or use tax
has been paid? ........................................................................ No Yes
• If yes, during what years?
• Describe property

13. Has this company made deliveries into Wisconsin using a company owned or operated vehicle? ........ No Yes
• If yes, during what years?
• Describe property

Are return for-hire trips (back-hauls) made? .................................................. No Yes
Are sales made by the vehicle driver(s)? ..................................................... No Yes

A-816 (R. 11-15) ‑ 2 ‑

- 3 -

D. Employees, Locations and Property – Answers should include information for the current year plus the
prior seven years.
1. Has this company or its employee(s) or representative(s) maintained a business location in Wisconsin? ... No Yes
• If yes, during what years?
• Provide the location(s), telephone number and number of persons at each location, along with their duties.

2. Has this company owned, leased or rented any real or tangible personal property located in Wisconsin? .. No Yes
• If yes, during what years?
• Provide the type, location and value of property.

3. Has this company stored any tangible personal property in Wisconsin? ............................ No Yes
• If yes, during what years?
• Provide the type, value and location of property stored in Wisconsin.

4. Has this company owned goods in a Wisconsin warehouse, on consignment, or in the hands of
a distributor or other non‑employee representative in Wisconsin? ................................. No Yes
• If yes, during what years?
A. Are these goods used to fill orders for its customers in Wisconsin? .............................. No Yes
B. Are these goods used to fill orders for an affiliate company’s customers in Wisconsin? .............. No Yes

5. Is this company listed in any telephone or Internet directories showing a Wisconsin address? ........... No Yes
Are Wisconsin home telephone numbers of any employees or representatives listed in local
advertisements for this company? .......................................................... No Yes
• If yes, provide the telephone numbers
( ) ( ) ( ) ( )

6. Has this company used a telephone answering service and/or call center in Wisconsin? ............... No Yes
• If yes, list the name and address of the answering service and/or call center.

7. Has this company paid salaries, wages, fees or commissions to any persons living in Wisconsin? ....... No Yes
• If yes, during what years?
• What were the duties of such persons?

Were any of the duties performed in Wisconsin? .............................................. No Yes
Does this company have a standard form of written agreement with employees or representatives in
Wisconsin, or a job description for such persons? ............................................. No Yes
• If yes, enclose a copy (or copies) for our review.

E. Company Activities That May or May Not be Conducted in Wisconsin – Answers should include
information for the current year plus the prior seven years.
1. Does this company issue credit cards, debit cards, or travel and entertainment cards to cardholders with
a Wisconsin address? ................................................................... No Yes
• If yes, during what years?
• Describe

A-816 (R. 11-15) ‑ 3 ‑

- 4 -

E. Company Activities That May or May Not be Conducted in Wisconsin (Cont’d.) – Answers should
include information for the current year plus the prior seven years.

2. Does this company solicit business from potential customers in Wisconsin? ......................... No Yes
• If yes, during what years?
• Describe solicitation activity

3. Does this company perform services outside Wisconsin for which the benefits are received in Wisconsin? ... No Yes
• If yes, during what years?
• Describe services

4. Does this company license intangible rights for use in Wisconsin, including, but not limited to, trademarks,
trade names, patents, copyrights, franchises, software or other intangible rights? ..................... No Yes
• If yes, during what years?
• Describe intangible property

5. Does this company engage in transactions with customers in Wisconsin involving intangible property and
resulting in receipts flowing to the company from within Wisconsin? ................................ No Yes
• If yes, during what years?
• Describe intangible property

6. Does this company hold loans secured by real or tangible personal property located in Wisconsin? ....... No Yes
• If yes, during what years?
• Describe property

F. Activities of Owners, Employees or Representatives of This Company in Wisconsin – Answers
should include information for the current year plus the prior seven years.
1. Have employees of this company, or you as a sole proprietor, come into Wisconsin for the purpose
of selling, demonstrating or taking orders? ................................................ No Yes
• If yes, during what years?
A. Do orders have to be sent outside Wisconsin for approval or rejection? ........................ No Yes
B. Has immediate delivery been made from a stock of goods available in Wisconsin? ............... No Yes
2. Havenon-employee representatives or agents of this company come into Wisconsin for the purpose of
selling, demonstrating or taking orders? .................................................. No Yes
• If yes, during what years?
A. Do orders have to be sent outside Wisconsin for approval or rejection? ........................ No Yes
B. Have they made immediate delivery from a stock of goods carried with them, or otherwise available
to them in Wisconsin? ............................................................. No Yes
3. Do any employees or representatives of this company, or do you as a sole proprietor, perform any of
the following business activities in Wisconsin?
A. Represent other principal firm(s) in Wisconsin ........................................... No Yes
B. Maintain an in home office that is publicly attributed to the company .......................... No Yes
C. Maintain an office outside their home .................................................. No Yes
D. Maintain a showroom or stock of goods ................................................ No Yes
E. Receive reimbursement from this company for office, storage area or showroom ................. No Yes
F. Receive business callers at office or showroom .......................................... No Yes
G. Deliver sold merchandise from stock carried with them .................................... No Yes
4. If yes to any questions 3A through 3G, during what years?
A-816 (R. 11-15) ‑ 4 ‑

- 5 -

F. Activities of Owners, Employees or Representatives of This Company in Wisconsin (Cont’d.) –
Answers should include information for the current year plus the prior seven years.

5. Do any employees or representatives of this company, or do you as a sole proprietor, perform any of
the following business activities in Wisconsin?
A. Accept payments or deposits from customers ........................................... No Yes
B. Collect delinquent accounts ........................................................ No Yes
C. Arrange dealer/customer storage of inventory ........................................... No Yes
D. Exchange or replace unsuitable merchandise ........................................... No Yes
E. Accept returned or repossessed merchandise ........................................... No Yes
F. Resolve dealer/customer complaints .................................................. No Yes
G. Adjust accounts with credit memos, etc. ............................................... No Yes
H. Assemble or install merchandise ..................................................... No Yes
I. Perform repairs or maintenance of merchandise ......................................... No Yes
J. Approve installers or repair service providers ........................................... No Yes
K. Supervise or inspect installation or repair service ........................................ No Yes
L. Conduct credit investigations or arrange for credit or financing .............................. No Yes
M. Arrange advertising ............................................................... No Yes
N. Recruit or hire new employees or representatives, other than sales representatives .............. No Yes
O. Train new or existing employees or representatives, other than sales representatives ............ No Yes
P. Terminate employees or representatives, other than sales representatives ..................... No Yes
Q. Accompany employees or representatives to customer calls, other than sales calls .............. No Yes
R. Locate or investigate potential service providers ......................................... No Yes
S. Approve dealer’s or customer’s employees ............................................. No Yes
T. Train dealer’s or customer’s employees ................................................ No Yes
U. Engage in purchasing activities ...................................................... No Yes
V. Engage in research or testing activities ................................................ No Yes
W. Engage in engineering or consulting activities ........................................... No Yes
X. Negotiate, renew or complete contracts or agreements .................................... No Yes
Y. Perform construction activities ...................................................... No Yes
Z. List any other business activities performed in Wisconsin:
6. If yes to any questions 5A through 5Z, during what years and how frequently per year, in terms of activity days?
One person for any part of one day is an activity day. (Note: Ten persons for one day or one person for ten days are both ten activity days.)

G. Ownership and Related Entity Information
1. Is this company a parent company? No Yes
2. Is this company a subsidiary? No Yes
3. Does this company file on a federal consolidated return? No Yes
• If yes to question 2 or 3, provide parent company information
Legal Name of Parent Company FEIN

Address

City State Zip

4. Does this company own, directly or indirectly, a general or limited partnership interest in a partnership
that does business in Wisconsin, regardless of the percentage of ownership? ....................... No Yes
• If yes, during what years?
5. Does this company 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 income tax purposes? ................................................ No Yes
• If yes, during what years?

A-816 (R. 11-15) ‑ 5 ‑

- 6 -

G. Ownership and Related Entity Information (continued)
6. Is this company a shareholder or member of an S corporation or limited liability company that has
operations, conducts business or owns real property in Wisconsin? ............................... No Yes
• If yes, during what years?
7. Does this company have any other affiliated or related entities? .................................... No Yes
• If yes, during what years?
8. If yes to any questions G4 through G7, provide company information below.
Legal Name FEIN Relationship

Address Description of any business activity in Wisconsin

City State Zip
No business activity in Wisconsin
Legal Name FEIN Relationship

Address Description of any business activity in Wisconsin

City State Zip
No business activity in Wisconsin
Legal Name FEIN Relationship

Address Description of any business activity in Wisconsin

City State Zip
No business activity in Wisconsin
Attach a separate sheet if necessary.

H. Other Information
1. List all the states in which this company conducts business.

2. Of the above states, in which states is this company filing franchise / income tax returns?

3. Is this company registered with any other Wisconsin state agency, (e.g. for unemployment compensation,
workman’s compensation, etc.)? ........................................................... No Yes
• If yes, list agency 

4. Has this company filed any franchise/income, sales/use or withholding tax returns in Wisconsin? ......... No Yes
• If yes, complete the boxes below.
Legal Name Identification number the Return Year(s)
returns were filed under Type Filed

I. Preparer and Signature Information
Name (print or type) Title

Signature Email Address

Telephone Number Date
( )

A-816 (R. 11-15) ‑ 6 ‑

PDF file checksum: 563663521

(Plugin #1/9.12/13.0)