FOR OFFICE USE ONLY 
                                                                              ACCOUNT #_____________ 
                                                           
                      APPLICATION FOR SALES AND/OR USE TAX 
                                     MADISON COUNTY, ALABAMA 
 
INSTRUCTIONS:    COMPLETE            EACH  LINE.    A  NUMBER  CANNOT  BE  ISSUED  UNTIL  THIS  FORM  IS 
COMPLETED.  TYPE OR PRINT LEGIBLY. 
                                                           
1)       Company Name                                                                                   
 
2)       Doing Business As (D/B/A)                                                                      
 
3)       Federal Employer Identification Number (FEIN)                                                  
 
4)       Number of business locations in Madison County                                                 
 
5)       Address(es) of business location(s) in Madison County (attach additional sheets if necessary) 
 
           City                                              State                        Zip Code 
 
6)       Mailing Address                                                                                
 
                                 City                                 State               Zip Code 
 
7)       E-mail Address                                                                                 
 
8)       Type of business (grocery, hardware, clothing sales, etc.)   
          
         Please check one: 
         (    )  Principally Wholesale    (    )  Contractors – Use 
         (    )  Principally Retail       (    )  Other 
 
         Please check one: 
         (    )  Corporation (attach copy of Certificate of Incorporation) 
         (    )  Partnership 
         (    )  Sole Ownership 
 
9)       Check one:        (    )  Huntsville City Limits  (    )  Outside City Limits 
 
10)      Former business name and owner                                                                 
 
11)      Date retail sales and/or use tax began (begin) in Madison County                               
 
12)      Person to contact if questions arise                                                           
 
         Business #                        Extension                       Home #                       
          
13)      Filing Status, Please check one: 
         (    )  Monthly  (gross taxable amount is greater than $2000/month) 
         (    )  Quarterly  (gross taxable amount is less than $2000/month) 
         (    )  Semi-annually 
         (    )  Annually  
         * We DO NOT offer an OCCASIONAL filing status.  You MUST choose a status listed above. 

14) Information regarding each owner or corporate officer.  Attach additional sheets if necessary. 
 
    Name                                                                                            
     Title                                                                                          
     Social Security Number                                                                         
     Date of Birth                                                                                  
     Home Address                                                                                   
                                                                                                    
                        City                                State        Zip Code 
     Home Telephone Number                                                                          
     
    Name                                                                                            
     Title                                                                                          
     Social Security Number                                                                         
     Date of Birth                                                                                  
     Home Address                                                                                   
                                                                                                    
                        City                                State        Zip Code 
     Home Telephone Number                                                                          
     
    Name                                                                                            
     Title                                                                                          
     Social Security Number                                                                         
     Date of Birth                                                                                  
     Home Address                                                                                   
                                                                                                    
                        City                                State        Zip Code 
     Home Telephone Number                                                                          
 
15) Signature of owner, all partners, or elected officers: 
 
                                                                 Date                               
 
                                                                 Date                               
 
                                                                 Date                               
 
16) Mail completed application to:  Madison County Sales Tax Department 
                                    Madison County Courthouse 
    FAXED COPIES WILL               100 Northside Square 
    NOT BE ACCEPTED                 Huntsville, AL 35801-4820 
                                    (256) 532-3498