| Business\Organization Name: * |
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| Business\Organization Street Address: * |
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| Business\Organization City, State, Zip: * |
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| Billing\Mailing Name (if different from above): |
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| Billing\Mailing Address (if different from above): |
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| Main Business Phone Number: * |
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| Secondary Phone Number: |
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| Fax Phone Number: |
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| Business Website (if any): |
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| Products or Services Provided: * |
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| Organization Type: * |
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| Owner\Contact Name: * |
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| Owner\Contact E-Mail Address: * |
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| Owner\Contact Home Address, City, State, Zip: * |
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| Other Owner\Contact Name: |
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| Other Owner\Contact Home Address, City, State, Zip: |
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| Other Owner\Contact Phone: |
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| Other Owner\Contact Email: |
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| Desired Tax Return Filing Frequency: * |
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| If Seasonal, please list Exact Months of your Season: * |
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| Business Start Date In Sterling: * |
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| Colorado State Tax ID Number: * |
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| Federal ID Number: * |
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| Application Date: * |
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