U.S. DEPARTMENT OF COMMERCE

Economics and Statistics Administration

U.S. CENSUS BUREAU

FORM

SM-4512BS-A

MONTHLY RETAIL TRADE REPORT

(05-25-2017)

CONTINUE ON PAGE 2

44523017

Due Date

Need help or have questions?

Call 1-800-772-7852

(8:30 a.m. - 5:00 p.m. ET, M-F)

 or Visit

https://econhelp.census.gov/mrts

Title 13 United States Code (U.S.C.),

Sections 131 and 182, authorizes the

Census Bureau to conduct this collection

and to request your assistance. The

U.S. Census Bureau is required by

Section 9 of the same law to keep your

information confidential and can use

your responses only to produce statistics.

The Census Bureau is not permitted

to publicly release your responses in a

way that could identify your business,

organization, or institution. Per the

Federal Cybersecurity Enhancement Act

of 2015, your data are protected from

cybersecurity risks through screening of

the systems that transmit your data.

This collection has been approved by

the Office of Management and Budget

(OMB). The eight-digit OMB approval

number is 0607-0717 and appears at

the upper right of this page. Without

this approval, we could not conduct this

survey. (Please correct any errors in name, address, and ZIP Code.)

Return via Internet: Return via Fax: To view Survey Results:

https://econhelp.census.gov/mrts 1-800-447-4613 https://www.census.gov/retail

Username:

Password:

GENERAL INSTRUCTIONS

• Any significant change in this firm's operations should be noted in 5

• For establishments sold or acquired during the month, report data only for the period the establishment was operated by this firm

• Estimates are acceptable if book figures are not available

 

• Enter "0" where applicable

INCLUDE EXCLUDE

•

•

Data for auxiliary facilities primarily engaged in supporting services

to this firm's establishment(s) such as warehouses, garages, central

administrative offices, and repair services

Leased departments and concessions operated in other establishments

•

•

 

•

Leased departments and concessions operated by other firms in this

firm's establishments

Sales taxes and finance charges

Data for establishments operated by other firms, such as franchises

ANNOUNCEMENTS AND SPECIAL INSTRUCTIONS

1 FEDERAL EMPLOYER IDENTIFICATION (EIN)

Has this firm acquired any new EINs for its retail operation(s) since last month? EIN (9 digits)

Yes - List here and continue with 2 . Report additional EIN(s) in 5 . ..........

No

2 NUMBER OF RETAIL ESTABLISHMENTS Number

How many retail establishments did this firm operate? .........................

The remainder of this report refers to the establishments reported here.

OMB No. 0607-0717: Approval Expires 6/30/2020
Form SM-4512BS-A (05-25-2017) Page 2

44523025

3 SALES, RECEIPTS, OR REVENUE

INCLUDE

 EXCLUDE

 

• Cash and credit sales of merchandise whether or not payment was

received 

• Commissions from vending machine operators and from sales of

government lottery tickets

 

•

 

•

 

•

E-commerce sales if not submitted on a separate monthly retail report

Wholesale sales and services revenue made by retail establishments

covered by this report

Value of trade-ins taken as part payment for other merchandise

 

•

 

•

 

•

Nonoperating receipts (such as interest income, income from

investments, and receipts from the rental or sale of real estate)

Refunds and allowances for returned goods

The actual value of rebates and discounts granted to the purchaser,

even if granted as an increase in trade-in allowance

A.

 

What type of reporting period do this month's sales represent?

Calendar month reporting period - Go to 3 C

 4-week reporting period 5-week reporting period

 

Ending Date

 

Month

 

Day

B.

 

If not a calendar month reporting period, what is the ending date for the period you are reporting sales?

C.

 

What were the total sales in

 Dollars

1.

 

Main store sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

 

Leased department sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

D.

3.

 

Total department store sales . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Do the sales reported in 3 C represent book figures or estimates?

Book Figure

 Estimate

E.

 

Did this firm have any e-commerce sales in

F.

Yes

 No - Go to 4

 Dollars

What were the total e-commerce sales in

 . . . . . . . . . . . . . . .

OR Percent

If e-commerce sales not available - What was the percent of total sales in 3 C that represents e-commerce? 

%

4 VALUE OF INVENTORIES

INCLUDE

 EXCLUDE

 

• The cost value of all merchandise for the end of the month

 • Items such as fixtures, equipment, and supplies not held for resale

 

• Merchandise owned by this firm but held by others for consignment

 • Merchandise owned by others such as those held on consignment

 

•

 

•

Merchandise under contract for sale

Merchandise if title has passed to you, including merchandise in transit 

• Merchandise of leased departments and concessions operated by

other firms in this retail establishment

 

• Inventory held in Foreign Trade Zones or in bond warehouses in the U.S.

A.

 

What was the value of merchandise inventories, regardless of where held, owned as of the end of the month?

1. Merchandise inventories in retail stores

Include leased departments and concessions operated by this firm in other

establishments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 Dollars

2. Merchandise inventories in warehouses, offices, or in transit for distribution to retail

stores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

 

Total inventories (if applicable, before Last-in, First-out (LIFO) adjustment) . . . . . .

 

Month

 

Day

B.

 

Inventories were reported as of what date? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 REMARKS - Please use this space to explain any significant month-to-month changes, to clarify responses, or indicate where data were

estimated.

CONTACT INFORMATION

Name of person to contact regarding this report Title

Telephone

Area code

 Number

 

- Extension

 Fax 

Area code

 Number

 

-

 DEFINITIONS OF E-COMMERCE SALES, AUXILIARY ESTABLISHMENTS, LEASED DEPARTMENTS AND CONCESSIONS

 

• E-commerce is the sale of goods and services where the buyer places an order, or the price and terms of the sale are negotiated, over an Internet, mobile device (MCommerce), extranet, EDI network, electronic mail, or other comparable online system. Payment may or may not be made online.

 

• Auxiliary Establishments are facilities primarily engaged in furnishing supporting services (such as warehouses, garages and central administrative offices) to this

firm's establishments.

 

• Leased Departments and Concessions are separate businesses that lease space on the premises of another business.

We estimate this survey will take an average of 7 minutes to complete, including the time for reviewing instructions, searching existing data sources, gathering and

maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this

voluntary collection of information, including suggestions for reducing this burden, to: EID Survey Comments 0607-0717, U.S. Census Bureau, 4600 Silver Hill Road, Room

EID-8K170, Washington, DC 20233. You may email comments to eid.retail.indicator.branch@census.gov. Be sure to use "EID Survey Comments 0607-0717" as the subject.