Free Application for Electronic Waste Recycling Fee Account - California

BOE-400-ER (FRONT) REV. 4 (9-07)

STATE OF CALIFORNIA

APPLICATION FOR ELECTRONIC WASTE RECYCLING FEE ACCOUNT
SECTION I: SALES OR USE TAX ACCOUNT INFORMATION
1. PLEASE ENTER YOUR SALES AND/OR USE TAX ACCOUNT NUMBER(S) (if registered with the Board of Equalization)

BOARD OF EQUALIZATION FOR BOARD USE ONLY
ER ER

ELECTRONIC WASTE RECYCLING FEE General Information Beginning January 1, 2005, the retail sale of covered electronic devices (CEDs) is subject to the electronic waste recycling fee. If you are a retailer who sells devices covered by the fee, you must register with the Board of Equalization (Board), collect the fee from your customers, file quarterly fee returns, and pay the collected fees to the Board. For more information on the fee, see our website: www.boe.ca.gov/sptaxprog/ewaste.htm. Registration Requirements To register for the fee, please complete, sign, date, and return this application in person or by mail. Be sure to complete all four sections. We cannot process your application if it is incomplete or if you do not sign in Section IV. Be sure to record your seller's permit number or use tax account number in Section I above. Your registration may be delayed without this information. Filing Requirements Feepayers are required to file a return and pay the fees on a quarterly basis. Your return and payment will be due on or before the last day of the month following the end of the calendar quarter (the due date is the last day of the month following the reporting period). You must file a return every quarter even if you do not collect any fees. Depending on your fee collections, we may require you to file returns and pay the fee on a monthly or yearly basis instead of quarterly. SECTION II: OWNERSHIP INFORMATION
2. PLEASE CHECK TYPE OF OWNERSHIP

Sole Owner

Husband & Wife Co-Ownership Corporation

Registered Domestic Partnership Other

Limited Partnership

General Partnership

Limited Liability Company (LLC)

3. OWNER NAME(S) (include all individual owners, general partners or full corporate, limited liability company (LLC), or organization name) (attach additional page if necessary)

SECTION III: BUSINESS INFORMATION
4. BUSINESS OR TRADE NAME (DBA if any) 5. BUSINESS TELEPHONE NUMBER 6. BUSINESS EMAIL ADDRESS CITY 7. BUSINESS WEBSITE ADDRESS

(

)

www.
STATE ZIP CODE

8. BUSINESS ADDRESS (do not list PO Box or mailing service)

9. MAILING ADDRESS (if different from No. 8 above)

CITY CITY

STATE STATE

ZIP CODE ZIP CODE

10. ADDRESS WHERE BUSINESS RECORDS WILL BE MAINTAINED

11. TYPES OF PRODUCTS SOLD

Computers/Monitors

Televisions

Laptops

Portable DVD players

Other CEDs

(check website for other types)

12. DATE YOU WILL BEGIN SELLING CEDs

13. NAME OF BANK OR OTHER FINANCIAL INSTITUTION

14. BANK BRANCH LOCATION AND ACCOUNT NUMBER

Business
15. NAME OF MERCHANT CREDIT CARD PROCESSOR (if you accept credit cards)

Personal

Both
16. MERCHANT CARD ACCOUNT NUMBER

17. NAME OF MAJOR CALIFORNIA BASED SUPPLIERS (list two) AND ADDRESSES (street, city, state, zip code)

18. PRODUCTS PURCHASED

SECTION IV: CERTIFICATION
I certify and declare, under penalty of perjury, that the information contained herein is correct to the best of my knowledge and that I am authorized to sign and certify this application.
NAME (type or print) DATE

YOUR SIGNATURE AND TITLE

CONTACT NUMBER

(

)

Return Application to: Board of Equalization, Waste Reduction Section PO Box 942879, Sacramento, CA 94279-0088

FOR BOARD OF EQUALIZATION TAX ASSISTANCE
ELECTRONIC WASTE RECYCLING FEE 916-341-6906 INFORMATION CENTER 800-400-7115 TTY/TDD 800-735-2929 TAXPAYERS' RIGHTS ADVOCATE 888-324-2798

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BOE-400-ER (BACK) REV. 4 (9-07)


ELECTRONIC WASTE RECYCLING FEE
PROGRAM PRIVACY NOTICE

Information Provided to the Board of Equalization

The Board of Equalization requires information about your business when you register to collect and report the Electronic
Waste Recycling (Ewaste) Fee.* This information is only used to administer the statewide fee program. You must provide all
of the information, including your social security number.**
Are my records private?
The information you provide is used to ensure the correct fees are reported and paid. State laws protect the privacy of tax
and feepayer records. With your written permission, we can release information regarding your account to anyone you
designate.
What happens if I don't provide the information?
If your application is incomplete, we may not be able to register your business.
If your return is incomplete, you may have to pay penalties and interest. Other penalties may apply for failure to provide
information or providing false information.
Credit, exclusion or adjustment claims that lack required information may not be granted.
We must collect information in order to administer the Ewaste fee.
We use the information you provide to ensure the correct amount of fees are being reported and paid.
We may disclose information to the proper officials of certain agencies, including but not limited to:
United States government agencies: U.S. Attorney's Office; Internal Revenue Service
State of California government agencies and officials: California Integrated Waste Management Board; Department
of Toxic Substances Control; Highway Patrol; California Parent Locator Service
City attorneys and city prosecutors; county district attorneys, police and sheriff departments.
Can I review my records?
Yes. If you need more information, you may contact our Disclosure Officer in Sacramento by calling 916-445-2918. You
may also want to obtain publication 58-A, How to Inspect and Correct Your Records. You may order a copy from our
Information Center at 800-400-7115 or download it from the Internet at www.boe.ca.gov (look under "Forms &
Publications," "All Publications," How to Inspect and Correct Your Records).
Who is responsible for maintaining my records?
The Chief of the Environmental Fees Division, whom you may contact by calling 916-341-6906, or writing to:
Chief, Environmental Fees Division, MIC:48
450 N Street
Sacramento, CA 95814
* The Electronic Waste Recycling Fee Program is administered under Chapter 8.5 (commencing with section 42460) of Part 3
of Division 30 of the Public Resources Code. The Board of Equalization is required to collect the fees pursuant to the Fee
Collection Procedures Law, Part 30 (commencing with section 55001) of Division 2 of the Revenue and Taxation Code.
** (used for identification purposes [see Title 42 U.S. Code sec. 405(c)(2)(C)(i)]).