Business License Application Form (City Of Wilmington, Delaware)

Application For Business License

City of Wilmington, Delaware

Department of Finance

License Number (Office Use Only)

Wage/Business License Division

800 N. French Street 19801-3537

(302) 576-2415

1. APPLICATION DATE

3. FEDERAL EMPLOYERS ID #

3A. If No FEI, Enter Applicant

SOCIAL SECURITY NO.

4. License Applied For:

Soc Sec. No.-

LICENSE TYPE CODE

(SEE OTHER SEE)

2. BUSINESS START DATE (IN CITY)

4A. SPECIFIC NATURE OF BUSINESS

5. STATE OF DE. LIC. NO.

FOR OFFICE USE ONLY

Additional Required Accounts

G

Net Profit

6. Applicant’s Business Location: Actual Physical Location. P.O. Box is not acceptable.

Acct # _______________________

E-MAIL ADDRESS

NAME OF BUSINESS (No more than 30 characters including spaces)

Wage/head

G

Acct # _______________________

ADDRESS LINE 1

FAX #

Date Added _______________

By __________________________

ADDRESS LINE 2

CITY

STATE

ZIP CODE

TELEPHONE NUMBER

CONTACT PERSON

7 . Business Owner Information: Actual Physical Location Required. P.O. Box Address is not acceptable.

FIRST NAME

NAME OF BUSINESS' OWNER(S)

LAST NAME

ADDRESS LINE 1

TELEPHONE NUMBER

ADDRESS LINE 2

CITY

STATE

ZIP CODE

TELEPHONE NUMBER

9. Type of Ownership:

8. Mailing Address (address applicant desires license information & tax forms to be mailed):

G

G

Corporation

S - Corporation

NAME OF BUSINESS

*

G

G

Partnership*

Sole Proprietor

G

G

Non-Profit (501C3 copy required)

Estate/Trust

ADDRESS LINE 1

G

Holding Company,

(if exempt under DEL. 1902(B)(8), Title 30 proof

of exemption must be attached)

,

G

LLC

G

Other

ADDRESS LINE 2

CITY

STATE

ZIP CODE

TELEPHONE NUMBER

Number of employees anticipated within City of Wilmington per month: ___________________________

*Attach a list of all partners’ names, addresses, and Social Security (or Federal Identification) Numbers

For purpose of Disadvantaged Business Program, please check here if you are a Disadvantaged Business Enterprise:

G

___________________________________________________________________________________________________________________________________________________________________________

DATE

PRINT NAME

SIGNATURE

TITLE

ZONING

FEE (Return Application with Fee) ___________________________________________________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________________________________

**PLUMBING INSPECTOR APPROVAL

**REQUIRED SIGNATURE FOR TESTED LICENSES