License Application Transaction Privilege & Use Tax - City Of Chandler
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1City of Chandler
LICENSE APPLICATION
Telephone: (480) 782-2280
TRANSACTION PRIVILEGE & USE TAX
Fax: (480) 782-2295
Location Address: 55 N. Arizona Pl. #105, Chandler, AZ 85225
Mailing Address: MS 701 - PO Box 4008, Chandler, AZ 85244-4008
Check one:
Permanent
Temporary
License No.:
New Business
Former Owner (if applicable)
Previous City License #
Check one:
New Owner of Existing Business
Check any
Name Change Only
Current City License #
Date of Change
Location Change
that apply:
SECTION I. BUSINESS INFORMATION
Business Name (Individual, Company or "DBA", first name first):
Location Address:
City, State, Zip Code + 4:
Business Phone (Including Area Code):
Start Date:
E-mail address:
State License #:
Federal ID #:
SECTION II. MAILING ADDRESS & PHONE NUMBER
Enter Name if Different from Section I (above) or Enter Care-Of Name:
Mailing Address:
City, State, Zip Code + 4:
Phone (Including Area Code):
SECTION III. BUSINESS OWNERSHIP & RECORD LOCATION
Ownership:
Individual
LLC
Corp. - State Inc.______
Gen. Partnership
Ltd. Partnership
Other _____________
1)
Name
Title
Owners, Partners,
LLC Members, or
Home Address
Social Security #
Officers
(For Additional Names,
City
State
ZIP Code
Phone No.
Please Attach List)
(
)
2)
Name
Title
Home Address
Social Security #
City
State
ZIP Code
Phone No.
(
)
Corporate or LLC
Name
Phone No.
(
)
Statutory Agent
Name
Phone No.
Location Where
(
)
Business Records
Address
City
State
ZIP Code
Are Kept
Section IV. Business Type
Business Type
Retail Sales
Restaurant/Bar
Amusement
Construction Contracting
Use Tax
Wholesaler
Manufacturer
Commercial Rental
Residential Rental (# of Units ______ )
Hotel/Motel
Other____________
Describe Nature of
Contractors #
Business
Check method you will use in submitting reports:
Cash Receipts
Accrual
# of Employees
Section V. Business Premises Status
Check one:
Do you own your business location?
Yes
No
If yes, Is this your residence?
Yes
No
If no, complete Landlord/Property Manager information
Landlord/Property Manager Name
Address
Phone #
(
)
Do you rent a portion of the business premises to another entity?
Yes
No
I certify that the statements made in this application are true and complete to the best of my knowledge. I accept the permit authorized and issued in
response to this application with the condition that I report timely and pay any and all taxes due by me to the city. Incomplete forms may not be processed.
IF APPLICABLE, BE SURE ALL SALES TAX HAS BEEN PAID BY FORMER OWNER. BY LAW YOU MAY BE LIABLE FOR ANY UNPAID TAX.
Print Name
Signature
Title
Date
License App. Rev. 6/2000
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