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                                 NC-592                                                                                      PRINT                    CLEAR
     Web-Fill                    Electronic Data Interchange (EDI)                                             DOR
     5-23                                                                                                      Use
                                 Registration Sales and Use Tax                                                Only
Business Name(First 30 Characters)  (USE CAPITAL LETTERS FOR NAME AND ADDRESS)                                 Date of Registration

Street Address                                                                                                    Account ID Number

City                                                                           State Zip Code (First 5 digits)               (If applicable)
                                                                                                               SST ID Number 
                                                                                
Mailing Address (If different from Street Address)                                                                       FEIN or SSN

City                                                                           State Zip Code (First 5 digits) Fill in applicable circle:
                                                                                                                         New Registration
                                                                                                                         Revised Registration

Name of Primary Contact Person                     Phone Number                      E-mail Address

Name of Alternate Contact Person                   Phone Number                      E-mail Address

Part 1.    Electronic Data Interchange (EDI)
     Please complete this section if you will be filing a Sales and Use Tax Return using the North Carolina EDI file format.
     EDI is available for ALL filing frequencies (Quarterly, Monthly, and Monthly with Prepayment.)  
Fill in applicable circle.
                                                                                                               Filing Frequency:  
This Business:                   Is a Software Developer.                                                      (Do not complete if Software Developer)
                                 Name of Tax Package Produced                                                  Quarterly
                                                                                                               Monthly
                                                                                                               Monthly with Prepayment
                                 Purchases a Tax Package from a Software Developer.
                                 Name of Software Developer                          Name of Tax Package

                                 Develops Software for Internal Use Only.

Part 2.    Registration Agreement
This business agrees to file a Sales and Use Tax Return using the North Carolina EDI file format and agrees to use version 4010 or the latest 
version of ANSI X.12 standards, and to comply with all the provisions in the following publications:
• North Carolina Department of Revenue EDI Technical Specifications
• North Carolina Department of Revenue Software Developer Test Package for Electronic Filing of Sales and Use Tax Returns
I certify that, to the best of my knowledge, the Sales and Use Tax Returns filed electronically for this business using the North Carolina Department of 
Revenue’s website are accurate and complete.

Authorized Signature                                            Title                                                    Date

               Mail To:  North Carolina Department of Revenue, Post Office Box 25000 Raleigh, NC 27640-0640