Wisconsin Department of Revenue
APPLICATION FOR DIRECT PAY PERMIT                                                             Division of Income, Sales and Excise Tax
                                                                                                              Tax Operations Bureau
•  Complete this entire form including answers to all questions below.                                                PO Box 8902
                                                                                                           Madison WI  53708-8902
•  Send the original to the Wisconsin Department of Revenue.
                                                                                                FOR DEPARTMENT USE ONLY
•  Retain a copy for your records.                                                            Direct Pay Permit Number

                                                                                              Date Issued

 Print Name of Applicant                                                                      Wisconsin Tax Account Number

 Address (Number and Street or Rural Route)                                                   Federal Employer ID Number

 City or Post Office                                     State           Zip Code             Fiscal Year Ending Date

 Name of Contact Person                                                                       Phone

                                                                                              (         )
 Type of Business                                                                             NAICS Code

  1.  Do you regularly make purchases of tangible personal property or taxable services under circumstances where it is 
       difficult to determine whether the property will be subject to sales or use taxes?

                          Yes                     No *

      If Yes, what is the approximate annual amount of these purchases (excluding
      purchases for resale) that would be subject to use tax in Wisconsin? .................  $

  2.  Will the use of a direct pay permit significantly reduce your work in administering sales and use taxes?

                          Yes                     No *

  3.  Will your accounting system clearly indicate the amount of tax owed when items are purchased without tax using a 
       Direct Pay Permit?
                          Yes                     No *

   *If you answered no to questions 1 or 2 above, please attach an explanation of why you are applying for a direct pay permit.
   If you answered no to question 3, attach an explanation of how you will determine your tax liability.

                                                  CERTIFICATION
I certify that the above statements are correct to the best of my knowledge and that I am authorized to sign the application.

 Signature                                                         Title                      Date

 Print Name

A Direct Pay Permit will be mailed to you if your application is approved. This permit allows a purchaser to purchase taxable 
products and certain taxable services without Wisconsin sales and use tax, even though no exemption applies. Use tax is then 
reported by the purchaser when the product or service is stored, used, or consumed in a taxable manner.
S-101 (R. 3-13)

How to Apply for a Permit

  1.  Complete the Application for Direct Pay Permit

  2.  Send the completed application to:

    Registration Unit
    Wisconsin Department of Revenue
    PO Box 8902
    Madison WI  53708-8902

Requirements for Obtaining a Direct Pay Permit

The Department of Revenue will issue a direct pay permit to you at the beginning of your taxable 
year if the following seven requirements are fulfilled:

  1.  Issuing the permit will significantly reduce the work of administering the sales and use taxes 
 because of the nature of your business.

  2.  Your accounting system will clearly indicate the amount of tax you owe.

  3.  You make enough taxable purchases to justify the expense of regular audits by the Department 
 of Revenue.

  4.  You are not liable under ch. 71, 72, 76, 77, 78, or 139, Wis. Stats., for delinquent taxes (including 
 costs, penalties, surcharges, and interest) of $400 or more if any part of the tax is delinquent for 
 at least 5 months.

  5.  It is in the state’s best interests to issue the permit.

  6.  You purchase enough tangible personal property under circumstances that make it difficult to 
 determine whether the property will be subject to sales or use tax.

  7.  You hold a valid business tax registration certificate under sec. 73.03(50), Wis. Stats.

If you have Questions about Direct Pay Permits

If you have any questions regarding direct pay permits (or other questions relating to sales, use, or 
withholding taxes) you may contact the department:

  •  by telephone in  Milwaukee  (414) 227-4000
            Madison   (608) 266-2776

  •  by fax (608) 267-1030

  •  by e-mail   dorbusinesstax@revenue.wi.gov

  •  through our web site at   www.revenue.wi.gov

You may write to the  Department of Revenue
            PO Box 8949
            Madison WI  53708-8949