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Form                                                                                                               Wisconsin Department of Revenue
                                               Registration Verification                                                       Nexus Unit  2‑233
 A-001                                                                                                                         PO Box 8906
                                                                                                                            Madison WI  53708‑8906
Complete this form to document your business’s Wisconsin tax status.  If you do not                                         Phone:  (608) 266‑3969
verify that your business and its affiliates are registered for Wisconsin sales or use tax                                     FAX:  (608) 266‑5464
or that all sales are exempt, Wisconsin state agencies and authorities may not purchase 
                                                                                                                            website:  revenue.wi.gov
products or services from the business or affiliates.
A.  Identification

Case ID:
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              C Corporation                    S 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).

Affiliate Information
Do you have affiliates* selling products or services in Wisconsin? .............................. Yes  No
If Yes, complete and attach Affiliate Registration Verification (Form A‑002).
* “Affiliate” means a person or business that controls, is controlled by, or is under common control with another person or 
 business. “Control” means to own, directly or indirectly, more than 10% of the interest in, or voting securities of, a business.
A-001 (R. 4-18)                                                                                                                (see back)
                                                                                                             Go to Page 2

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

 8. What year did you start selling products/services to Wisconsin customers? ......................

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-001 (R. 4-18)                                     ‑ 2 ‑