*0-0-701-099*  
                                                                                                                              *0-0-701-099* 

                             Wyoming Department of Revenue                                         
                                Excise Tax Division 
                             122 West 25th Street, Herschler Bldg 
                                Cheyenne, Wyoming 82002-0110 
                                http://revenue.wyo.gov 
                              
                                 Construction Project and General Contractor Registration 

 Please note that the general contractor must complete and remit this form to the above address within 15  
 Days of the project start date. 
 
 Project Information: 

 1. Project Name____________________________________________________________________________ 
 2. Physical Address of Project:_________________________________________________________________ 
 3. Project Owner:___________________________________________________________________________ 
 4. Total Project/Contract Amount:______________________________________________________________ 
 5. Anticipated Start Date:___________________ Anticipated Completion Date:_________________________ 

 General Contractor Information: 

 6. General Contractor Legal Name:__________________________________FEIN/SS#__________________  
 7. MailingAddress:__________________________________________________________________________ 
 8. City, State, Zip:__________________________________________________________________________ 
 9. Phone Number:__________________________(800)Number_________________Fax#_________________ 
 10. Contact Person:___________________________________________________________________________ 
 11. E-Mail Address:__________________________________________________________________________ 
 12. Will there be any non-resident subcontracts on this project?   Yes________________No_________________ 
 13. Describe your scope of work:________________________________________________________________ 
                                                                   (remodel, renovation, new construction, office bldg. etc.) 
     
    Note: You must enclose a copy of the bid that describes the scope of work you were contracted to 
    perform.) 
     
    We have been contracted by:______________________________________to be the General Contractor for 
    the project identified above. 
     
    We estimate the materials for this project will be: $_______________________________________ 
     
    I declare under penalty of perjury m the information provided above is correct and complete. 
     
    Authorized Signature:_______________________________________Title:__________________________ 
     
    Printed Name:_____________________________________________Date:__________________________ 
                                      
    ETS from 701 revised 9/14/16      (This form may be duplicated as necessary)