IMP App (rev. ) 1 APPLICATION FOR IMPORTER222S LICENSE Importer: Means a person who manufactures or wholesales, through employees or agents, any article of upholstered furniture, bedding, or filling material manufactured outside of the United States for the purpose of sale or resale in California (Home Furnishings and Thermal Insulation Act, Article 3, Section 19011.1). It shall be unlawful for any person to engage in a business regulated by the Home Furnishings Act unless, at the time of doing so, he/she holds a valid, unexpired license to engage in such business (Home Furnishings and Thermal Insulation Act, Article 3, Section 19049). Applications and Fees sent by courier must be sent to: 1625 North Market Blvd., Ste S-100, Sacramento, CA 95834. To obtain an Importer license, an applicant shall submit this application along with the appropriate fee to the Bureau222s Licensing Division. You must complete all information on both sides of the application that applies to your business. Each license is issued for a two-year period. Make check or money order for $50.00 payable to BHFTI. Checks or money orders must be from a United States bank in United States currency. Do Not Send Cash. Mail completed application form and fees to the above address. Wire transfers will not be accepted. An original signature is required to process the application. Please type or print your information. It is mandatory that you complete this application with all information that pertains to your business. Omission of any item of requested information will result in a delay of the application process and issuance of a license. The information on this application is required pursuant to California Business and Professions Code sections 19049 and 19050. The information provided will be used to determine qualifications for licensure as provided by Chapter 3 of Division 8 of the Business and Professions Code. The collection of this information is authorized by the Business and Professions Code Section 30 and the Information Practices Act. Personal information may be disclosed in the following circumstances: a Public Records Act request as allowed by the Information Practices Act (Civil Code Section 1798 and following), another government agency as required by law, or in support to a court or administrative order. You have a right of access to records containing personal information about you maintained by the Department of Consumer Affairs, unless the records are exempted from disclosure by Section 1798.40 of the California Civil Code. Individuals may obtain information regarding the location of their records by contacting the Public Records Request Coordinator at the following address and telephone number P.O. Box 980580, West Sacramento, CA 95798-0580 or (916) 999-2041. Registry Number. The location of every manufacturer or importer who manufactures shall bear a separate registry number. A registry number uniquely identifies each location (branch house) of a licensed manufacturer, importer. The registry number must appear on the law label that is attached to all upholstered furniture, bedding or filling materials. Every person who is subject to licensure shall obtain a separate license for each business location. Anyone whose manufacturing plant is located in another state or foreign country, and who is licensed to manufacture upholstered furniture or bedding or filling material for sale in California, may have one wholesale outlet operated in the same name in California, covered by the license issued to the factory (Section 19060). Disclosure of your social security number (SSN) or Individual Taxpayer Identification Number (ITIN) is mandatory for all sole proprietors and partners of domestically based companies. Federal Employer Identification Number (FEIN) is also mandatory for partnerships of domestically based companies. Section 30 of the Business and Professions Code and Public Law 94-455 (42 USCA 405(c)(2)(C)) authorizes collection of your SSN. Your SSN, ITIN, or FEIN will be used exclusively for tax enforcement purposes, for the purposes of compliance with any judgment or order for family support in accordance with Section 11350.6 of the Welfare and Institutions Code, or for verification of licensure or examination status by a licensing or examination entity which utilizes a national examination and where licensure is reciprocal with the requesting state. If you fail to disclose the required identification number(s), your application for initial or renewal license will not be processed AND you will be reported to the Franchise Tax Board, which may assess a penalty against you per Section 19528 of the Revenue and Tax Code. NOTICE: Effective July 1, 2012, the State Board of Equalization and the Franchise Tax Board may share taxpayer information with the bureau. You are obligated to pay your state tax obligation and your license may be suspended if the state tax obligation is not paid. Keep this page for your reference. Do not mail with your application If you have difficulty accessing any material on this application because of a disability, please contact us in writing or via telephone at the number or e-mail address listed at the top of the application and we will work with you to make the information available. Bureau of Electronic and Appliance Repair, Home Furnishings and Thermal Insulation 4244 South Market Court, Suite D, Sacramento, CA 95834 - 1243 P (916) 999 - 2041 F (916) 921 - 7279 www.bearhfti.ca.gov BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY 225 GOVERNOR EDMUND G. BROWN JR. American LegalNet, Inc. www.FormsWorkFlow.com IMP App (rev. ) 2 APPLICATION FOR IMPORTER LICENSE - $750 To obtain an Importer license, an applicant shall submit this Application for Importer License alongwith the appropriate fee to the Bureau222s Licensing Division.Each license is issued for a two-year period.Make check or money order for $50.00 payable to BHFTI. Checks or money orders must be from a United States bank in United States currency. Do Not Send Cash. Wire transfers will not be accepted.Please type or print your information. An original signature is required to process the application. Omission of any item of requested information will delay the issuance of a license. Bureau of Electronic and Appliance Repair, Home Furnishings and Thermal Insulation 4244 South Market Court, Suite D, Sacramento, CA 95834 - 1243 P (916) 999 - 2041 F (916) 921 - 7279 www.bearhfti.ca.gov For Department Use Only Receipt #: Fee: File I.D.#: Class or Type: License #: Registry #: SECTION 1 : Applicant Information 1. Name of Business (DBA) 2. Address of Business (Address of Record) Country 3. Mailing Address (If Different from Addres s of Record) Country 4. Area Code & Phone Number ( ) - Area Code & Fax Number ( ) - Web Site Address (URL) 5. Corporate Name or Parent Company 6. Corporate Headquarters Address Country 7. Contact Person Email 8). Have you or your firm ever held a license issued by the BHFTI? Yes No License #: Expiration Date: 9. SOLE PROPRIETOR/PARTNERSHIP: Print owner's and each partner222s name, residence address, date of birth, and social security number(s) (SSN) or Individual Taxpayer Identification Number (ITIN). If a partnership, also list FEIN. (Attach additional sheets if necessary.) (1)Name: Area Code & Telephone Number ( ) - Residence Address: Number and Street City State Zip Code Country SSN / ITIN : FEIN: (If Partnership) Date of Birth: (2)Name: Area Code & Telephone Number ( ) - Residence Address: Number and Street City State Zip Code Country SSN / ITIN : FEIN: (If Partnership) Date of Birth: 10. Corporation LLC : List all officers/members with titles and date of birth . Attach additional sheets if necessary. (1 ) Name: Title or Position: Date of Birth (2) Name: Title or Position: Date of Birth Address: Address: City State Zip code Country City State Zip Code Country BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY 225 GOVERNOR EDMUND G. BROWN JR. American LegalNet, Inc. www.FormsWorkFlow.com IMP App (rev. ) 3 11. Are any of the applicants in item 9 or 10 (owners, general partners, or corporate officers) currently serving or have previously served in the US mi