Prototype Form Prototype Form

Attachment C-1
2012 Economic Census
Wholesale Trade
Prototype Form

Prototype Form: 4/27/11

2012 ECONOMIC CENSUS

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

Motor Vehicles

FORM

WH-42301

OMB No. : Approval Expires

(DRAFT)

DUE DATE
FEBRUARY 12, 2013
WH-42301

Mail your completed form to:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47134-0001
Please read the accompanying
information sheet(s) before
answering the questions.
Need help or have questions
about filling out this form?
Visit www.census.gov/
econhelp
Call 1-800-233-6136, between
8:00 a.m. and 6:00 p.m., Eastern
time, Monday through Friday.
- OR Write to the address above.
Include your 11-digit Census File
Number (CFN) printed in the
mailing address.

(Please correct any errors in this mailing address.)

YOUR RESPONSE IS REQUIRED BY LAW. Title 13, United States Code, requires businesses and other organizations
that receive this questionnaire to answer the questions and return the report to the U.S. Census Bureau. By the same
law, YOUR CENSUS REPORT IS CONFIDENTIAL. It may be seen only by persons sworn to uphold the confidentiality
of Census Bureau information and may be used only for statistical purposes. Further, copies retained in respondents'
files are immune from legal process.
• Use blue or black ballpoint pen.
• Do not use pencil or felt-tip pen.
• Place an "X" inside the box.

• Please center numbers in their respective boxes.
• Do not put slashes through 0 or 7.

Examples:

0 1 2 3 4 5 6 7 8 9

The reporting unit for this form is an establishment. An establishment is generally a single physical location
where business is conducted or where services or industrial operations are performed. For further clarification, see
information sheet(s).
1

EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) shown in the mailing address the same as the one used for this
establishment on its latest 2012 Internal Revenue Service Form 941, Employer's Quarterly Federal Tax Return?
0021

2

2

No - Enter current EIN (9 digits)

0022

-

0025

PHYSICAL LOCATION
A. Is this establishment's physical location the same as shown in the mailing address?
(P.O. Box and rural route addresses are not physical locations.)
0031

42301010

Yes - Go to

0032

Yes - Go to line B
No - Enter
physical
location

0035

Number and street

0036

City, town, village, etc.

0037

State

0038

ZIP Code

B. Is this establishment physically located inside the legal boundaries of the city, town, village, etc.?
(Mark "X" only ONE box.)
0041

Yes

0042

No

0043

No legal boundaries

0044

Do not know

C. In what type of municipality is this establishment physically located? (Mark "X" only ONE box.)
0046

City, village, or borough

PENALTY FOR FAILURE TO REPORT

USCENSUSBUREAU

0047

Town or township

0048

Other

0024

Do not know

CONTINUE ON PAGE 2

Prototype Form: 4/27/11
Form WH-42301
3

Page 2

(DRAFT)

OPERATIONAL STATUS
Which ONE of the following best describes this establishment's operational status at the end of 2012?
(Mark "X" only ONE box.)
0011

In operation

0014

Ceased operation - Give date at right

0015

0013

Temporarily or seasonally inactive
Month

Sold or leased to another operator - Give date at right
AND enter name and address of new owner or operator
and Employer Identification Number (EIN) below
0060

Day

Year

0018

Name of new owner or operator

0061

EIN (9 digits)

0062

Mailing address (Number and street, P.O. Box, etc.)

0063

City, town, village, etc.

0064

State

0065

ZIP Code

0016

4

Other - Specify

0815

Mark "X" 2012
if None Number

MONTHS IN OPERATION
Number of months in operation during 2012 (If none, mark "X" and go to

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

0002

2012

Mark "X"
if None $ Bil.

Dollar figures should be rounded to
thousands of dollars.

HOW TO
REPORT
DOLLAR
FIGURES
5

30 .)

Mil.

Thou.

If a figure is $2,035,628.79:

Report

2 0 3 6

If a value is "0" (or less than $500.00):

Report

EXAMPLE

SALES, SHIPMENTS, RECEIPTS, OR REVENUE
A. Sales and operating receipts (Include the gross selling value of business
conducted for others. Include shipping and handling charges. Exclude
sales taxes and Hawaii's General Excise Tax.) . . . . . . . . . . . . .

Dol.

2012

Mark "X"
if None $ Bil.

Mil.

$ Bil.

Mil.

Thou.

Dol.

Thou.

Dol.

0100

42301028

B. Did this establishment earn commissions for the sale of merchandise?
1121

Yes - Go to line C

1122

No - Go to line E

2012

C. Gross selling value of business conducted on a commission basis (Include on
line A.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1123

D. Commissions received on transactions reported on line C . . . . . . . . . .

1124

E. Is this the only establishment of this firm?
0907

Yes - Go to line G

0908

No - Go to line F

F. Percent of products sold by this establishment manufactured or mined in the United States
by your company or its subsidiaries . . . . . . . . . . . . . . . . . . . . . . . . . .

Mark "X"
if None
1125

2012
Percent

%

G. Did e-commerce account for more than 50% of this establishment's sales and/or operating
receipts as reported on line A?
0308

Yes

0309

No
CONTINUE ON PAGE 3

Prototype Form: 4/27/11
Form WH-42301

Page 3

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
6

Not Applicable.

7

EMPLOYMENT AND PAYROLL
Include:
• Full- and part-time employees working at this establishment whose payroll was reported on Internal Revenue
Service Form 941, Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number
(EIN) shown in the mailing address or corrected in 1 .
Exclude:
• Temporary staffing obtained from a staffing service.
• Contractors, subcontractors, or independent contractors.
• Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN.
• Purchased or managed services, such as janitorial, guard, or landscape services.
• Professional or technical services purchased from another firm, such as software
consulting, computer programming, engineering, or accounting services.

A. Number of employees for pay period including March 12 . . . . . . . . . . . . . .

1. Annual payroll . . . . . . . . . . . . . . . . . . . . . . . . . .

0300

2. First quarter payroll (January-March, 2012)

0310

Not Applicable.

9

VALUE OF INVENTORIES

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

0320

Mark "X"
if None $ Bil.

B. Payroll before deductions (Exclude employer's cost for fringe benefits.)

8

2012
Number

Mark "X"
if None

For further clarification, see information sheet(s).

2012
Mil.

Thou.

Dol.

End of 2011
Mil.
Thou.

Dol.

A. Did this establishment own inventories, regardless of where held, at the end of 2012 and/or 2011?
0486

Yes - Go to line B

0487

No - Go to

16

B. Report inventories for products owned by this establishment as of December 31.
Mark "X"
if None $ Bil.

End of 2012
Mil.
Thou.

Mark "X"
if None $ Bil.

1. Total inventories
before Last-in, Firstout (LIFO) adjustment
(if any) . . . . . . . .

0460

0470

2. LIFO reserve (if any)

. .

0466

0476

3. Total inventories
after LIFO adjustment
(Line B1 minus line B2) .

0468

0469

42301036

Dol.

CONTINUE ON PAGE 4

Prototype Form: 4/27/11
Form WH-42301

Page 4

(DRAFT)

10 INVENTORIES BY VALUATION METHOD
Report how much of the inventory reported in
the following valuation methods.

A. LIFO valuation method before adjustment

9

, line B1 for 2012 is subject to

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

0244

B. First-in, First-out (FIFO) . . . . . . . . . . . . . . . . . . . . . . . .

0491

C. Average cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0492

D. Standard cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0493

2012

Mark "X"
if None $ Bil.

Mil.

Mark "X"
if None $ Bil.

Mil.

Thou.

Dol.

Thou.

Dol.

E. Other valuation method - Specify method
0494

0895

F. TOTAL (Add lines A through E. Total should equal

9

, line B1.) . . . . .

0490

11 – 15 Not Applicable.
16 SELECTED EXPENSES

A. Operating expenses (Include payroll. Exclude cost of goods sold and
interest expense.) . . . . . . . . . . . . . . . . . . . . . . . . . . .

0140

B. Purchases of merchandise for resale, net of returns, allowances, and
trade and cash discounts (Include amounts allowed for trade-ins.) . . . .

1160

2012

C. For the value reported on line B, were any of these goods ordered over an Internet, Extranet, Electronic Data
Interchange (EDI) network, electronic mail, or other online system?
Yes

0442

No

0443

Do not know

42301044

0441

CONTINUE ON PAGE 5

Prototype Form: 4/27/11
Form WH-42301

Page 5

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
17 and 18 Not Applicable.
19 A. KIND OF BUSINESS
Which ONE of the following best describes this establishment's principal kind of business in 2012?
(Mark "X" only ONE box.)
0700

423 110 10 1

New and used automobiles and motorcycles

441 110 00 3

Retail new and used motor vehicle dealer

425 120 31 1

Automobile auction, wholesale

423 110 10 2

All-terrain vehicles (ATVs), snowmobiles, motor scooters, mopeds, and other motorized
recreational-use vehicles

423 110 20 1

Buses, recreational vehicles (RVs), motor homes, and campers

423 110 30 1

Light trucks, 14,000 lb. or less

423 110 40 1

Medium trucks and tractors, 14,001 lb. to 33,000 lb.

423 110 50 1

Heavy trucks, road tractors, and truck trailers, over 33,000 lb.

336 211 00 1

Truck equipment distributor/upfitter primarily completing trucks by installing and assembling
truck bodies and/or other equipment onto truck chassis

777 420 00 1

Truck equipment distributor primarily reselling equipment, parts, and accessories, with or
without installation onto completed vehicles

423 120 10 1

New motor vehicle parts, warehouse distributor, sold primarily to jobbers or other wholesalers

423 120 20 1

New motor vehicle parts, jobber, sold primarily to retailers and repair shops

423 140 10 2

Used motor vehicle parts and supplies dealer

441 310 50 2

Retail used automotive parts dealer

423 130 00 1

Tires and tubes

423 830 30 2

General-purpose industrial machinery

811 111 00 8

General motor vehicle repair shop

771 000 00 1

Other kind of business - Specify

42301051

0701

19 B. TYPE OF OPERATION
Which ONE of the following best describes this establishment's principal type of operation in 2012?
(Mark "X" only ONE box.)
Merchant wholesaler, buying and selling on own account
0600

12

Importer

13

Exporter

11

Merchant wholesale distributor or jobber

14

Own-brand importer and marketer

20

Manufacturers' sales branch or office
CONTINUE WITH

19

ON PAGE 6
CONTINUE ON PAGE 6

Prototype Form: 4/27/11
Form WH-42301

Page 6

(DRAFT)

19 B. TYPE OF OPERATION - Continued
Agent, broker, or commission merchant
0600

46

Manufacturers' representative or agent

41

Auction company

42

Broker, representing buyers and sellers

43

Commission merchant

44

Import agent

45

Export agent

49

Electronic market - business-to-business marketplace that facilitates the sale of goods via the
Internet or other electronic means, and operates on a commission or fee basis

77

Other broker or agent - Specify

0601

20 CLASS OF CUSTOMER
A. As a general business practice, did this establishment sell to household consumers and individual users in 2012?
0251

Yes

0252

No

B. Were 75% or more of this establishment's sales to retailers/wholesalers/distributors for resale in 2012?
0256

Yes

0257

No

42301069

C. Did this establishment require proof of business or professional license from new customers in 2012?
0276

Yes

0277

No

CONTINUE WITH

20

ON PAGE 7

CONTINUE ON PAGE 7

Prototype Form: 4/27/11
Form WH-42301

Page 7

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
20 CLASS OF CUSTOMER - Continued
2012
Whole percent
of sales and
receipts

D. Estimate the percentage of this establishment's total sales (reported in 5 , line A) by class of
customer. (Circle all that apply and then report percentages for the items circled.)
1.

Household consumers and individuals

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

0261

2.

Export sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0262

3.

Retailers for resale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0263

4.

Wholesalers/distributors for resale

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

0264

5.

Repair shops for use in repair work . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0265

6.

Manufacturing and mining industrial users for use as input goods in production

. . . . . .

0266

7.

Restaurants, hotels, food services, and contract feeding . . . . . . . . . . . . . . . . . .

0267

8.

Businesses for end use in their own operation, not for resale or production . . . . . . . . .

0268

9.

Building contractors, heavy construction, and special trade contractors . . . . . . . . . . .

0269

10. Farmers for use in farm production . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0270

11. Governmental bodies (federal, state, and local)

0271

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

%
%
%
%
%
%
%
%
%
%
%

12. Other - Specify

0874

%

0272

13. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 0 0 %

42301077

21 METHOD OF SELLING
Which ONE of the following best describes this establishment's principal method of selling in 2012?
(Mark "X" only ONE box.)
0751

Electronic commerce (selling goods or facilitating the sale of goods via the Internet or other electronic means)

0752

Store or display showroom (selling from a fixed or permanent location with physical displays of priced
merchandise and/or from a counter)

0753

Warehouse or office (including telephone/fax orders or outside sales representatives)

0754

Mail order

0755

Home shopping via television

0756

Direct selling (selling in a face-to-face manner away from a fixed location, such as house-to-house, party
plan, or temporary kiosk sales)

0757

Vending machines

0758

Other - Specify

0759

CONTINUE ON PAGE 8

Prototype Form: 4/27/11
Form WH-42301

Page 8

(DRAFT)

2012
Estimates are acceptable.
Report dollars OR percents.

HOW TO
REPORT
PERCENTS

$ Bil.

If figure is 38.76% of
total sales:

Mil.

Thou.

Dol.

Percent

Report whole percents

3 9

22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
(Report sales for each product line sold by this establishment, either as a dollar figure or as a whole percent of total
sales reported in 5 , line A. Include the value of merchandise marketed under capital, finance, or full payout leases,
and rental receipts derived from merchandise under operating leases. See HOW TO REPORT DOLLAR FIGURES on page
2 and HOW TO REPORT PERCENTS above. Do not combine data for two or more lines.)
2012
Census
use

Description of sales, shipments, receipts, or revenue

Estimates are acceptable.
Report dollars OR percents.
$ Bil.

0723

1.

0720

a. New automobiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10111

b. Used automobiles

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

10112

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

10113

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

10114

e. All-terrain vehicles (ATVs), snowmobiles, motor scooters, mopeds,
and other motorized recreational-use vehicles . . . . . . . . . . . . . .

10115

f. Sum lines 1a through 1e

10100

d. Utility trailers

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

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

b. New light truck, van, and SUV bodies

10134

c. Used light trucks and SUVs . . . . . . . . . . . . . . . . . . . . . . . . .

10132

d. New and used vans and cargo vans . . . . . . . . . . . . . . . . . . . .

10133

e. Sum lines 2a through 2d . . . . . . . . . . . . . . . . . . . . . . . . .

10130

Percent
0722

Medium trucks, truck bodies, and tractors, 14,001 lb. to 33,000 lb.

b. New medium truck bodies

42301085

Dol.

10131

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

a. New medium trucks and tractors

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

10141

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

10143

c. Used medium trucks and tractors
d. Sum lines 3a through 3c
4.

Thou.

Light trucks and truck bodies, 14,000 lb. or less, including vans, cargo
vans, and SUVs
a. New light trucks and SUVs

3.

Mil.

New and used automobiles, motorcycles, and trailers

c. Motorcycles

2.

0721

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

10142

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

10140

Heavy trucks, truck bodies, trailers, and road tractors, more than 33,000
lb.
a. New heavy trucks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10151

b. New heavy truck tractors

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

10152

c. New truck trailers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10153

CONTINUE WITH

22

ON PAGE 9
CONTINUE ON PAGE 9

Prototype Form: 4/27/11
Form WH-42301

Page 9

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE - Continued
2012
Census
use

Description of sales, shipments, receipts, or revenue

Estimates are acceptable.
Report dollars OR percents.
$ Bil.

0723

4.

0720

d. New heavy truck bodies . . . . . . . . . . . . . . . . . . . . . . . . . . .

10154

e. Used heavy trucks, tractors, and trailers

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

10155

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

10150

Thou.

Dol.

Percent
0722

Buses, campers, and motor homes
a. Buses

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

10121

b. Motor homes, travel trailers, and campers . . . . . . . . . . . . . . . .

10122

c. Sum lines 5a and 5b . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10120

6.

Transportation equipment, including golf carts

12630

7.

New and rebuilt automotive and trailer parts and supplies (Report parts
installed in repair work on line 19b.)

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

a. Automotive batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10211

b. Complete engines

10212

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

c. Electrical engine parts, including ignition parts

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

10213

d. Brake parts, including fluid and all disk and drum parts . . . . . . . .

10214

e. Exhaust system parts

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

10215

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

10216

f. Automotive glass

g. Hoses, belts, gaskets, and wiper blades

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

h. Filters, including oil, air, gas, and transmission

j. Body parts and repair materials

10218

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

10219

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

10221

k. Suspension parts, including shocks, struts, and ball joints

. . . . . .

l. Automotive accessories, excluding car stereos and CD players

10222

. . .

10224

. . . . . . . .

10223

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

10200

m. Other automotive parts and supplies, including wheels
n. Sum lines 7a through 7m

10217

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

i. Engine parts, excluding electrical parts

42301093

Mil.

Heavy trucks, truck bodies, trailers, and road tractors, more than 33,000
lb. - Continued

f. Sum lines 4a through 4e
5.

0721

8.

Used automotive parts, accessories, and equipment

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

10240

9.

Automotive chemicals, including polishes and cleaners, fuel and oil
additives, and antifreeze . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15347

CONTINUE WITH

22

ON PAGE 10
CONTINUE ON PAGE 10

Prototype Form: 4/27/11
Form WH-42301

Page 10

(DRAFT)

22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE - Continued
2012
Description of sales, shipments, receipts, or revenue

Census
use

Estimates are acceptable.
Report dollars OR percents.
$ Bil.

0723

0720

0721

Mil.

Thou.

Dol.

Percent
0722

10. Tires and tubes
a. New automobile tires and tubes

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

10311

b. Re-treaded and used automobile tires and repair materials . . . . . .

10312

c. New truck and bus tires, including industrial, off-road, and farm
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
tractor tires

10313

d. Re-treaded and used truck and bus tires and repair materials,
including industrial, off-road, and farm tractor tires . . . . . . . . . .

10314

e. Sum lines 10a through 10d

10300

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

11. Car stereos, tape players, and CD players

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

11519

12. Refined petroleum products, excluding liquefied petroleum (LP) . . . . .

15400

13. Communications equipment and supplies

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

11650

14. Construction, forestry, and mining machinery and equipment, including
parts and attachments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12100

15. Farm machinery, equipment, and parts . . . . . . . . . . . . . . . . . . . .

12200

16. General-purpose industrial machinery, equipment, and parts . . . . . . .

12320

17. Miscellaneous commodities - Specify
a.

19811

b.

19812

c.

19813

18. Rental and operating lease receipts

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

19940

19. Service receipts and labor charges, including installed parts
a. Labor charges for repair work

42301101

b. Parts installed in repair work

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

19701

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

19702

c. Other service receipts and labor charges - Specify

19703

d. Sum lines 19a through 19c

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

19700

20. Receipts for machine shop job work, including receipts for custom built,
rebuilt, or repaired parts . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19980

21. Receipts for service contracts . . . . . . . . . . . . . . . . . . . . . . . . . .

19720

22. TOTAL (Should equal

19990

5

, line A if reporting in dollars.) . . . . . . . . . .

1 0 0
CONTINUE ON PAGE 11

Prototype Form: 4/27/11
Form WH-42301

Page 11

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
23 Not Applicable.
24 SHIPPING AND HANDLING
A. Did this establishment have any receipts from customers for shipping and handling of merchandise in 2012?
0981

Yes - Go to line B

0982

No - Go to

2012
Estimates are acceptable
$ Bil.
Mil.
Thou.
Dol.

26

B. Receipts of this establishment from customers for shipping and handling of
merchandise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C. Are receipts for shipping and handling included in sales and receipts (reported in
0988

Yes

0989

No

0985

5

, line A)?

25 Not Applicable.
26 SPECIAL INQUIRIES
A. EMPLOYMENT BY PRIMARY FUNCTION
(List the number of employees reported in
function.)
1. Selling

7

, line A, by the employee's primary

Census
use

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

1131

2. Sales support - including office, clerical, warehousing, customer service, maintenance
employees, and drivers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1132

3. General support of other establishments in your company - including central
administrative, accounting, research, and other support employees . . . . . . . . . . .

1133

4. Packaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1135

5. Production - including employees who manufacture products from raw materials or
semi-finished products (Report 'knockdown' assembly employees on line 6 below.) . . .

1136

6. 'Knockdown' assembly - assembling prefabricated components designed for a single
application or reassembly of completed products . . . . . . . . . . . . . . . . . . .

1134

2012
Paid employees

7. Other - Specify

1137

0837

42301119

8. TOTAL (Add lines 1 through 7. Total should equal

7

, line A.) . . . . . . . . . . . . .

1138

B. PERCENT OF DROP SHIPPED SALES
2012
Whole percent
of sales and
receipts

Percentage of sales (reported in 5 , line A) that were drop shipped and did not enter this
establishment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CONTINUE WITH

26

1111

%

ON PAGE 12

CONTINUE ON PAGE 12

Prototype Form: 4/27/11
Form WH-42301

Page 12

(DRAFT)

26 SPECIAL INQUIRIES - Continued
C. PURCHASE OF CONTRACT MANUFACTURING
1. Did this establishment purchase contract manufacturing services from other companies or foreign plants of
your company in 2012?
Include:
• Products for which the manufacturing (i.e., transforming or otherwise processing materials or
components based on specifications provided by your company) was outsourced to other companies.
• Products for which the manufacturing was performed by your company's foreign plants.
Exclude:
• Services for packaging and assembling.
• Purchases of merchandise for resale (sale of products bought and sold without further processing or
transformation).
1011

Yes - Go to line 2

1012

No - Go to

2012
30

$ Bil.

2. Report the costs incurred by this establishment for contract manufacturing
purchased in 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1013

3. Report the value of sales, shipments, receipts, or revenue generated in 2012
from products whose purchases were reported as contract manufacturing
costs in line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1015

Mil.

Thou.

27 – 29 Not Applicable.
REMARKS (Please use this space for any explanations that may be essential in understanding your reported data.)

$$CENSUS_REMARKS$$

30 CERTIFICATION - This report is substantially accurate and was prepared in accordance with the instructions.

42301127

Is the time period covered by this report a calendar year?
Yes

No - Enter time period covered

Month

FROM

Name of person to contact regarding this report

Area code

Telephone

Number

-

E-mail address

Year

Month

Year

TO
Title

Extension

Area code

Number

Fax
Date
completed

Month

Day

Thank you for completing your 2012 ECONOMIC CENSUS form.
PLEASE PHOTOCOPY THIS FORM FOR YOUR RECORDS AND RETURN THE ORIGINAL.

Year

Dol.