Company Name                                                       Utah Sales Tax Acct. Number E-mail Address   

Street Address                                                                                 Telephone Number

City                                                               County                      State       Zip Code

Check the box next to each city in which your customers have their place of primary use. For customers whose primary place of use is 
in the unincorporated area of a county, check the box directly beneath the county labeled "unincorporated."

Beaver County           Providence          03056                Falcon Hill Clearfield 06301    Cedar City               11003
Unincorporated  01000 Richmond            03059                Falcon Hill Sunset  06302       Enoch                    11005
Beaver City     01002 River Heights       03060                Duchesne County                   Kanarraville             11012
Milford         01008 Smithfield          03062                Unincorporated        07000     Paragonah                11018
Minersville     01009 Wellsville          03076                Altamont              07001     Parowan                  11019
Box Elder County        Trenton             03081                Duchesne City         07008     Brian Head               11028
Unincorporated  02000 Nibley              03098                Myton                 07017     Inland Port, Iron Springs 11501
Bear River      02004 Cache Valley Transit 03900               Roosevelt             07019     Juab County
Brigham         02017 Carbon County                              Tabiona               07020     Unincorporated           12000
Corinne         02025 Unincorporated      04000                Emery County                      Eureka                   12009
Deweyville      02032 Helper              04016                Unincorporated        08000     Levan                    12019
Elwood          02035 Price               04035                Castle Dale           08001     Mona                     12024
Fielding        02041 Scofield            04040                Clawson               08003     Nephi                    12026
Garland         02044 Wellington          04053                Cleveland             08004     Rocky Ridge Town         12030
Honeyville      02054 East Carbon         04058                Elmo                  08007     Santaquin South          12050
Howell          02057 Daggett County                             Emery City            08008     Kane County
Mantua          02069 Unincorporated      05000                Ferron                08009     Unincorporated           13000
Perry           02086 Dutch John          05002                Green River           08011     Alton                    13001
Plymouth        02090 Manila              05006                Huntington            08012     Glendale                 13002
Portage         02092 Davis County                               Orangeville           08016     Kanab                    13004
Snowville       02100 Unincorporated      06000                Garfield County                   Orderville               13007
Tremonton       02113 Bountiful           06004                Unincorporated        09000     Big Water                13010
Willard         02120 Centerville         06006                Antimony              09001     Millard County
Cache County            Clearfield          06008                Boulder               09002     Unincorporated           14000
Unincorporated  03000 Fruit Heights       06010                Bryce Canyon          09003     Delta                    14010
Amalga          03001 Farmington          06017                Cannonville           09004     Fillmore                 14014
Clarkston       03014 Kaysville           06026                Escalante             09005     Hinckley                 14023
Cornish         03017 Layton              06030                Hatch                 09006     Holden                   14024
Hyde Park       03032 North Salt Lake     06035                Henrieville           09008     Kanosh                   14026
Hyrum           03033 South Weber         06045                Panguitch             09011     Leamington               14028
Lewiston        03036 Sunset              06048                Tropic                09015     Lynndyl                  14030
Logan           03038 Syracuse            06049                Grand County                      Meadow                   14034
Mendon          03041 West Point          06056                Unincorporated        10000     Oak City                 14037
Millville       03044 Woods Cross         06057                Castle Valley         10005     Scipio                   14040
Newton          03047 Clinton             06059                Moab                  10011
North Logan     03049 West Bountiful      06061                Iron County
Paradise        03053 Falcon Hill Davis   06300                Unincorporated        11000     —continued on next page

Morgan County                         Bluff                     19004 Vernon              23050  Wallsburg                26014
Unincorporated               15000  Monticello                19009 Wendover            23052  Hideout                  26020
Morgan City                  15007  Sanpete County                    Rush Valley         23056  Mil. Rec. - Wasatch  26300
Piute County                          Unincorporated            20000 Lincoln             23065  Military Rec - Hideout 26301
Unincorporated               16000  Centerfield               20004 Stansbury Park      23066  Washington County
Circleville                  16003  Ephraim                   20008 Uintah County                Unincorporated           27000
Junction                     16005  Fairview                  20009 Unincorporated      24000  Apple Valley             27002
Kingston                     16006  Fayette                   20010 Naples              24014  Enterprise               27005
Marysvale                    16007  Fountain Green            20011 Vernal              24024  Hurricane                27008
Rich County                           Gunnison                  20014 Ballard             24028  Ivins                    27010
Unincorporated               17000  Manti                     20020 Utah County                  La Verkin                27011
Garden City                  17001  Mayfield                  20021 Unincorporated      25000  Leeds                    27012
Laketown                     17002  Moroni                    20023 Alpine              25001  New Harmony              27015
Randolph                     17005  Mt. Pleasant              20024 American Fork       25002  Rockville                27019
Woodruff                     17010  Spring City               20031 Bluffdale South     25010  St George                27020
Salt Lake County                      Sterling                  20032 Cedar Fort          25019  Santa Clara              27021
Unincorporated               18000  Wales                     20033 Draper City South  25029   Springdale               27023
Alta                         18003  Sevier County                     Eagle Mountain      25030  Toquerville              27024
Brighton                     18010  Unincorporated            21000 Fairfield           25035  Virgin                   27026
Bluffdale                    18019  Annabella                 21001 Genola              25038  Washington City          27027
Cottonwood Heights 18020            Aurora                    21002 Goshen              25043  Hildale                  27035
Draper                       18039  Central Valley            21007 Lehi                25066  Wayne County
Herriman                     18060  Elsinore                  21014 Lindon              25070  Unincorporated           28000
Holladay                     18065  Glenwood                  21018 Mapleton            25073  Bicknell                 28001
Midvale                      18093  Joseph                    21025 Orem                25083  Hanksville               28005
Millcreek                    18094  Koosharem                 21029 Payson              25085  Loa                      28007
Murray                       18096  Monroe                    21031 Pleasant Grove      25088  Lyman                    28008
Riverton                     18118  Redmond                   21033 Provo               25090  Torrey                   28010
Salt Lake City               18122  Richfield                 21034 Salem               25096  Weber County
Sandy                        18131  Salina                    21035 Santaquin           25097  Unincorporated           29000
South Jordan                 18138  Sigurd                    21038 Saratoga Springs  25098    Farr West                29012
South Salt Lake              18139  Summit County                     Highland            25099  Harrisville              29016
Taylorsville                 18142  Unincorporated            22000 Spanish Fork        25103  Hooper                   29018
West Jordan                  18155  Coalville                 22006 Springville         25106  Huntsville               29019
West Valley City             18167  Francis                   22013 Vineyard            25117  Marriot-Slaterville 29022
Utah Data Cntr SL Co 18300          Henefer                   22017 Cedar Hills         25123  North Ogden              29026
Copperton Tnshp  18401              Kamas                     22022 Elk Ridge           25124  Ogden                    29027
Emigration Canyon Tnshp 18402       Oakley                    22029 Woodland Hills      25125  Plain City               29030
Kearns Township              18403  Park City                 22030 Utah Data Cntr Ut Co 25300 Pleasant View            29031
Magna Township               18404  Snyderville Basin Transit 22900 Wasatch County               Riverdale                29036
White City Tnshp             18405  Tooele County                     Unincorporated      26000  Roy                      29037
Inland Port, Salt Lake City 18501   Unincorporated            23000 Charleston          26003  South Ogden              29040
Inland Port, West Valley City 18502 Erda City                 23018 Daniel              26005  Uintah                   29043
Inland Port, Magna  18503           Erda City West            23020 Heber               26008  Washington Terrace 29049
Inland Port, Salt Lake Cnty 18504   Grantsville               23023 Independence       26009  West Haven               29051
San Juan County                       Lakepoint                 23030 Interlaken          26010  Falcon Hill Riverdale    29300
Unincorporated               19000  Stockton                  23046 Midway              26011  Falcon Hill Roy          29301
Blanding                     19002  Tooele City               23048 Park City East      26013
                                                                                                                                
Contact Information 
Form Questions:    801-297-7566                General Information: 801-297-2200              Website: tax.utah.gov
                                                                        1-800-662-4335

                               If you need accommodations under the Americans with Disabilities Act, email taxada@utah.gov, 
                                      or call 801-297-3811 or TDD 801-297-2020. Please allow three working days for a response.