APPLICATION FOR BUSINESS LICENSE
FOR THE CITY OF WAYNESBORO
Commissioner of the Revenue
503 W Main St – Room 107
Waynesboro VA 22980-4512
(540) 942-6610
Instructions: Type or print clearly. Provide full information. Return to Commissioner of the Revenue Office with
check made payable to the City of Waynesboro
Circle One:
Individual
Partnership
Corporation
NAME: _________________________________________________________________
TRADING AS: ______________________________Contact Person _________________
LOCATION OF BUSINESS: _________________________________________________
MAILING ADDRESS: ______________________________________________________
PHONE NUMBER: _______________ DATE BEGAN/WILL BEGIN: __________________
FEDERAL ID/SS#________________ STATE LICENSE #: ________________________
COMPLETE DESCRIPTION OF BUSINESS ACTIVITY: ____________________________
(Use separate sheet if necessary)
______________________________________________________________________
______________________________________________________________________
Listed below is a formula for calculating the amount due for your business license. Refer to the first page
for info on the different categories & rates.
Est. Gross ________________ x Rate _______ = Total Due ____________________________
Declaration by Taxpayer :
I declare that the foregoing statement(s) and figures are true, full and correct to the
best of my knowledge and belief.
____________________________________
__________________________
Taxpayer’s Signature
Date
Make Check Payable To: City of Waynesboro
Mail to the Address Listed Above
Form BL