U.S. DEPARTMENT OF COMMERCE

Economics and Statistics Administration

U.S. CENSUS BUREAU

FORM

SM4212-E

OMB No. 0607-0190: Approval Expires 5/31/2014

 MONTHLY WHOLESALE TRADE REPORT 

(09-10-2012)

CONTINUE ON PAGE 2

42060012 Due Date

 

Need help or have questions?

 Call 1-800-772-7852

 

(8:30 a.m. - 4:30 p.m. ET, M-F)

YOUR CENSUS REPORT IS

CONFIDENTIAL. It may be

seen only by persons sworn to

uphold the confidentiality of U.S.

Census Bureau information and

may be used only for statistical

purposes. Under the same law,

information that you report

cannot be used for taxation,

regulation, or investigation and

are exempt from release under

the Freedom of Information Act.

Further, copies of your response

retained in your files are immune

from legal process.

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

Return via Internet:

 Return via Fax: To view survey results:

econhelp.census.gov/mwts

Username:

Password:

 1-800-447-4613

 census.gov/wholesale

 GENERAL INSTRUCTIONS

 

• This report should cover ALL wholesale distributor establishments in the United States reporting payroll

under the Employer Identification Number (EIN) as referenced in 1 on page 2

 

• Include data for auxiliary facilities primarily engaged in supporting services to this EIN's establishment(s)

such as warehouses, garages, and central administrative offices

 

• Any significant change in this EIN's operations should be noted in 5 on page 3

 

• For establishments sold or acquired during the month, report data only for the period the establishments

were operated by this EIN

 

• Estimates are acceptable if book figures are not available

 

• Enter "0" where applicable

 ANNOUNCEMENTS AND SPECIAL INSTRUCTIONS
-

Form SM4212-E (09-10-2012) Page 2

CONTINUE ON PAGE 3

42060020

1 FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN)

Does this firm report payroll under EIN

Yes

No - Enter current 9-digit EIN AND date payroll was first

reported for this EIN . . . . . . . . . . . . . . . . . . . . . . . . .

EIN (9 digits)

 

Month

 

Day

 Year

2 NUMBER OF ESTABLISHMENTS

How many wholesale establishments (including auxiliary facilities primarily engaged in

supporting services such as warehouses, garages, and central administrative offices) did this

EIN operate in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 Number

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

3 SALES, RECEIPTS, OR REVENUE

Include:

 Exclude

 

•

 

•

 

•

 

•

Sales of products that are shipped on this EIN's

orders directly to customers

Retail sales made by wholesale establishments

covered by this report

Gross value of sales made on a commission

basis (not this firm's actual commissions)

Receipts from freight, installations, rentals,

maintenance, repairs, alterations, storage, and

other such services

 

•

 

•

 

•

 

•

Sales from establishments that are primarily

selling products manufactured or mined in the

United States by this EIN

Foreign sales of products that never entered the

United States

Nonoperating receipts (such as interest income,

income from investments, and receipts from the

rental or sale of real estate)

Commissions earned for the sale of products

 

• Excise taxes (such as those on gasoline, liquor,

and tobacco) that are levied on the manufacturer

and included in the cost of products purchased by

this EIN

 

• Receipts from customers for carrying or other

credit charges

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

B.

 

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

reporting sales? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

Ending Date

 

Month

 

Day

 

$ Bil.

 Mil. Thou. Dol.

C.

 

What were this EIN's sales and other operating receipts in
-

Form SM4212-E (09-10-2012) Page 3

42060038

4 VALUE OF INVENTORIES

INCLUDE

 EXCLUDE

 

• All inventories of products covered by this

report, including auxiliary locations (such as

warehouses, garages, and central administrative

offices) servicing these establishments,

regardless of where held

 

•

 

•

Items such as fixtures, equipment, and

supplies not held for resale

Products owned by others that are being held

on consignment

 

• Inventory held in Foreign Trade Zones or in bond

warehouses in the United States

 

• Report at cost or market value as of the end of this

EIN's reporting period

A. Did this EIN own inventories, regardless of where held, at the end of the month (or the end of

the period for which you are reporting)?

Yes

No - Go to 5

B.

 

What was the value of inventories (before Last-in, First-out (LIFO)

adjustment)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

$ Bil.

 Mil. Thou. Dol.

C.

 

Were inventories reported as of

Yes - Go to 5

No

 

Month

 

Day

D.

 

If not end of the month, 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.

6 CONTACT INFORMATION

Name of person to contact regarding this report (Please print) Title

Telephone 

Area code

 Number Extension

 

- Fax 

Area code

 Number

 THANK YOU

for completing your Monthly Wholesale Trade Report.

 We suggest you keep a copy for your records.

Public reporting burden for this collection of voluntary information is estimated to average 7 minutes per response, including the time for assembling data

from existing records and completing the form. Send comments regarding this burden estimate or any other aspect of this collection of information, including

suggestions for reducing this burden, to: Paperwork Project 0607-0190, U.S. Census Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington, DC 20233. You

may e-mail comments to Paperwork@census.gov; use "Paperwork Project 0607-0190" as the subject. Respondents are not required to respond to any information

collection unless it displays a valid approval number from the Office of Management and Budget. This 8-digit number appears in the top right corner of this form.