Business License Application Form - City Of Portland, Oregon
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1
2PLEASE RETURN THIS FORM TO:
BUSINESS LICENSE
City of Portland
OMF - Revenue Bureau, License and Tax Division
APPLICATION
111 SW Columbia St, Suite 600
Portland, OR 97201
CITY OF PORTLAND OREGON
(503)823-5157
Attention: Unlicensed Compliance Team
Visit us on the web at:
License and Tax Division
Most information provided on this form is subject to disclosure under Public Record Law.
Account Number:
This form is to be used by businesses doing business in the Cit y of Portland Oregon and Multnomah
Reset Form
County If you conduct business within Multnomah County limits ONLY, but not in Portland, then
please complete the Multnomah County Business Income Tax Information Form ONLY.
BUSINESS NAME: ____________________________________________________________________________________
(Last Name, First Name - if Sole Proprietorship and Single Member LLC)
CONTACT NAME: __________________________________________ CONTACT PHONE: ________________________
DOING BUSINESS AS (DBA): ___________________________________________________________________________
(if different from BUSINESS NAME above)
Sole Proprietorship/ Single-
-
-
*
BUSINESS ENTITY TYPE:
S.S. #
Member LLC
S-Corporation
Partnership
Corporation
*
-
FEIN:
Ltd. Liability
Trust
Estate
Ltd. Partnership
Company
Non-Profit Corporation
*
(501c3)
This information i s not subject to public disclosure
BUSINESS FISCAL/TAX YEAR END
________________
(Sole Proprietorship and Single Member LLC is always a December Year-End):
DATE PORTLAND BUSINESS ACTIVITY BEGAN: ___________________ NUMBER OF OWNERS: __________________
(List Owners Names on back)
PRIMARY BUSINESS LOCATION ADDRESS - No PMB or P.O. Box Numbers (list additional business location addresses on back:
______________________________________________________________________________________________
BUSINESS ACTIVITY : __________________________________________________________________________________
Commercial
BUSINESS PHONE: ___________________________ BUSINESS PROPERTY TYPE:
Residential
MAILING ADDRESS - PMB or P.O. Box Numbers accepted:
(if different from PRIMARY BUSINESS LOCATION ADDRESS above):
_________________________________ __________________________________
This Section for Office Use Only - Application continued on back
DATE RECEIVED:
FOR OFFICE USE ONLY:
DATE ENTERED:
ACCOUNT #: ______________________ NAICS: ________________________
AMT RECEIVED: ____________________________
CASH/RECEIPT #: ___________________ CHECK # : ______________________
ATTENTION:
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