Emergency Auto Wrecker Permit Application/renewal - City Of Sulphur

RDS

Toll Free Phone: 800-556-7274

Attn: City of Sulphur License Renewal

Toll Free Fax: 844-528-6529

9618 Jefferson Highway, Suite D #334

Baton Rouge, LA 70809

YEAR _________CITY OF SULPHUR (1680) EMERGENCY AUTO WRECKER PERMIT

APPLICATION/RENEWAL

Please complete this application and return along with your payment

Current Date: ____________________________

RDS Account Number: _____________________

Business Name:____________________________________

Check here if you no longer operate in the City.

Business Address: __________________________________

Return Date Discontinued: _______/_____/_____.

_________________________________________________

Please return form to RDS.

Dear Business Owner,

This document serves as an application/renewal notice for your Emergency Auto Wrecker Permit. Please note that the license will

st

expire December 31

annually.

Please Complete:

Yes

No

( )

(

) Is your business located in the City limits of Sulphur? If so, you must purchase an Occupational License

(Schedule 204.00) in addition to the Emergency Auto Wrecker Permit. See Fee Schedule at

( )

(

) Outside of City Limits of Sulphur businesses: Attach a copy of your current Occupational License.

( )

(

) Inside and Outside City Limits of Sulphur businesses: Attach a copy of your Certificate of Liability Insurance.

( )

(

) Inside and Outside of City Limits of Sulphur businesses: Provide Model, Make, Vin# and Class for each vehicle.

Calculate Emergency Auto Wrecker Permit Fee Instructions:

Step 1. Number of Vehicles:

Fee Per Vehicle

Amount Due for Vehicles:

Class A __________________

$10.00 per vehicle

1A. $__________________

Class B __________________

$25.00 per vehicle

1B. $__________________

Step 2. Penalty:

2. $__________________

Step 3. Interest:

3. $__________________

Step 4. Total Remittance (Sum Amount Due for Vehicles, Penalty and Interest): 4. $__________________

Model

Make

Vin#

Class

___________ _________________ _____________________________________________________ __________

___________ _________________ _____________________________________________________ __________

___________ _________________ _____________________________________________________ __________

___________ _________________ _____________________________________________________ __________

Make check payable to “Tax Trust Account.” Remit payment to

RDS. Attn: City of Sulphur License Renewal,

9618 Jefferson Highway, Suite D #334, Baton Rouge, LA 70809

Signature of Applicant: _________________________________________ Title:__________________Date: ________________

Print Name of Applicant: ________________________________________ Telephone: _________________________________

Returned Check Disclaimer: Effective July 1, 2010, each returned item received by RDS due to insufficient funds will be electronically represented to the presenters’ bank no more than

two times in an effort to obtain payment. RDS is not responsible for any additional bank fees that will accrue due to the resubmission of the returned item. Please see the full returned

check policy at