including but not limited to distributing flyers
(address of authorized representative)
(address of organization)
(address of person signing)
(address of persons authorized representative when applicable)
(area code)
(CLEAR) CLEAR
(Date)
(organizations name)
(organizations website)
(out of state retailer)
(out of state retailer's name)
(persons name)
(previous year)
(PRINT) PRINT
(printed name of authorized representative)
(printed name of person signing)
(telephone number)
(title)
(to be completed by organizations)
(to be completed by persons operating in California)
1 The retailer s agreement prohibits persons operating under the agreement from engaging in any solicitation
1) the agreement provides that the organization will maintain information on its website alerting its members to the
2 The person or persons operating under the agreement in California certify annually under penalty of
3 The retailer accepts the certification or certifications in good faith and the retailer does not know or have
a club or non profit group is not subject to the affiliate nexus provision if in addition to the above requirements
A person may complete the Annual Certification of No Solicitation section on the next page or any document that
A retailer engaged in business in this state as defined in Revenue and Taxation Code (RTC) section 6203 is
activities in California that refer potential customers to the retailer including but not limited to distributing
addition Regulation 1684 provides that a retailer can demonstrate that an agreement is not an agreement subject to
ADDITIONAL STATEMENT FROM ORGANIZATION
ADDRESS OF AUTHORIZED REPRESENTATIVE (street city state zip code)
ADDRESS OF ORGANIZATION (street city state zip code)
ADDRESS OF PERSON S AUTHORIZED REPRESENTATIVE WHEN APPLICABLE (street city state zip code)
ADDRESS OF PERSON SIGNING (street city state zip code)
AFFILIATE NEXUS INFORMATION
agreement or agreements under which a person or persons in this state for a commission or other consideration
An organization may complete the Additional Statement from Organization section on the next page or any document
and the person named below has not engaged in prohibited solicitation activities in California that refers potential
ANNUAL CERTIFICATION BOARD OF EQUALIZATION
ANNUAL CERTIFICATION OF NO SOLICITATION
based link or an Internet website or otherwise provided that the retailer s sales exceed two specific sales
BOE 232 BACK (9 12)
BOE 232 FRONT (9 12) STATE OF CALIFORNIA
certification from the organization under penalty of perjury that includes a statement certifying that its website
certification requirements of Regulation 1684 for a minimum of eight years
coupons newsletters and other printed promotional materials or electronic equivalents verbal soliciting (for example
customers to at any time during the previous year
described above
described above The BOE recommends you retain this form or any other document that satisfies the annual
directly or indirectly refers potential purchasers of tangible personal property to the retailer whether by an Internet
does not apply if a retailer can demonstrate that all of the persons with whom the retailer has agreements described
engaged in any prohibited solicitation activities in California at any time during the previous year
engaged in business in this state and is required to register to collect California use tax if the retailer enters into an
flyers coupons newsletters and other printed promotional materials or electronic equivalents verbal
I HEREBY CERTIFY UNDER PENALTY OF PERJURY:
in person referrals) initiating telephone calls and sending emails
in the affiliate nexus provision did not directly or indirectly solicit potential customers for the retailer in California In
includes information directed at its members alerting them to the prohibition against the solicitation activities
Instructions for Annual Certification
is prohibited from engaging in any solicitation activities in California that refers potential customers to
ORGANIZATION S NAME
ORGANIZATION S WEBSITE
OUT 0F STATE RETAILER S NAME
OUT 0F STATE RETAILER S NAME XX XX XX TO XX XX XX
OUT OF STATE RETAILER
perjury that they have not engaged in any prohibited solicitation activities in California at any time during
PERSON S NAME
PRINTED NAME OF AUTHORIZED REPRESENTATIVE
PRINTED NAME OF PERSON SIGNING
printed promotional materials or electronic equivalents verbal soliciting (for example in person referrals) initiating
prohibition against each of the solicitation activities described above and 2) the retailer obtains an annual
property to California customers
reason to know that the certification or certifications are false or fraudulent
REGARDING SOLICITATION ACTIVITIES
Regulation 1684 further provides that a retailer can demonstrate that an agreement with an organization such as
required to register with the Board of Equalization (BOE) to collect and remit use tax on sales of tangible personal
RTC section 6203 subdivision (c)(5) includes an affiliate nexus provision Under the provision a retailer is
Sales and Use Tax Regulation 1684 Collection of Use Tax by Retailers explains that the affiliate nexus provision
satisfies the requirements of Regulation 1684 to annually certify under penalty of perjury that the person has not
SIGNATURE OF ORGANIZATION S AUTHORIZED REPRESENTATIVE DATE
SIGNATURE OF PERSON OR PERSON S AUTHORIZED REPRESENTATIVE DATE
soliciting (for example in person referrals) initiating telephone calls and sending emails;
telephone calls and sending emails
TELEPHONE NUMBER
that satisfies the requirements of Regulation 1684 to annually certify under penalty of perjury that its website
That the person named below is operating under an agreement with
That the website of the organization named below includes information that alerts its members that anyone operating
the affiliate nexus provision if:
the previous year; and
The prohibited solicitation activities include but are not limited to distributing flyers coupons newsletters and other
thresholds
TITLE
under the organization s agreement with