Application For Portland Business License Form
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1
2City of Portland Oregon
Bureau of Licenses
OFFICE USE ONLY
th
1900 SW 4
Ave Rm 3500
Portland OR 97201-5350
ACCOUNT #
Office: (503) 823-5157
FAX: (503) 823-5192
Web:
APPLICATION FOR PORTLAND BUSINESS LICENSE for
ANY business activity within the City of Portland, Oregon where total gross receipts for all business everywhere is $25,000 or more
annually. License fee is calculated at the rate of 2.2% of net income subject to fee; initial fee is subject to adjustment.
SOME OF THE INFORMATION PROVIDED ON THIS FORM MAY BE SUBJECT TO DISCLOSURE UNDER PUBLIC RECORD LAW
1)
NAME:
PRINT Name(s) of Owners, Partners, Corporation – as filed on the State of Oregon Tax Return
OWNERS
ALL PARTNERS
OWNERS: PLEASE LIST
OF CORPORATIONS (OWN 5% STOCK) &
ON THE BACK OF THIS FORM.
2)
BUSINESS NAME/Doing Business As (DBA):
[If different from above NAME]
3)
BUSINESS CONTACT NAME:
CONTACT TITLE:
CONTACT PHONE:
(
)
Is this person authorized to represent the licensee?
Yes
No
4)
TAX ENTITY:
Sole Proprietor
Partnership
Corporation
Estate
Trust
Ltd. Liability Co.
Ltd. Partnership
S – Corporation
Other:
(check one)
5)
FISCAL YEAR
BUSINESS FAX:
6)
TAX ENTITY ID # (Not subject to disclosure)
(
)
END:
F.E.I.N:
SS #:
7)
NUMBER OF
8)
DATE BUSINESS ACTIVITY
?
9)
Is there business activity outside Portland
Yes
No
OWNERS:
BEGAN IN PORTLAND:
IF YES, describe business activity outside Portland:
10)
BUSINESS ADDRESS: (location)
(Use back of form to list additional locations)
Number/Street - NOT PO BOX
City, State, Zip Code
11)
BUSINESS PHONE:
12)
PROPERTY TYPE: Is business address on:
(
)
COMMERCIAL
RESIDENTIAL property?
13) BUSINESS ACTIVITY DESCRIPTION:
(
Office Use Only)
SIC CODE:
If business activity includes rental/leasing residential or commercial property, list property addresses on back of this
form
14) MAILING ADDRESS:
( If different from line 10 above)
?
15) Is this a new business
Yes
No
IF business was previously licensed, give name of previous owner:
16) If any of the current owners of this business have a current or expired PORTLAND license, give account information:
NAME:
ACCOUNT#:
Year licensed:
M
$100.00 N
-R
Checks payable to: CITY OF PORTLAND
INIMUM FEE IS
ON
EFUNDABLE
:
$
PAYMENT:
CASH
RECEIPT #
CHECK #:
DUPLICATE:
NAME
DBA
FEIN
BUSINESS ADDRESS
SEND LETTER
OTHER
INITIALS
ADDRESS ON CHECK
PDX: Total $_________ Status: ______ TO: _________________ Comment:
PDX: Total $_________ Status: _____ TO: _________________ Comment
MULT: Total $_________ Status: ______ TO: _________________ Comment:
SIGNATURE IS REQUIRED ON BACK OF THIS FORM
COMPLETE BOTH SIDES OF APPLICATION –
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