Form A-101 - Application For Permit/certificate Page 2
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218. Do you have a location that is primarily engaged in the short-term rental of vehicles (Type-1 automobiles,
Yes
No
station wagons, mobile homes, motor homes or camping trailers) without drivers?
Do you provide limousine service?
Yes
No
19. Provide the following information for sole proprietor, all general partners of a partnership (if only one general partner, please write “no other
general partners” in second column), all members of an LLC (if only one member, please write “no other members” in the second column), or
the principal officers of a corporation. If additional space is needed, attach a separate sheet.
NAME
SOCIAL
SECURITY
NUMBER
HOME
ADDRESS
CITY,
STATE &
ZIP
TITLE
PARTNERS
PERCENT (%)
OF OWNERSHIP
20. If you have more than one (1) permanent location, indicate the business name and business address of each location. If additional space
is needed, attach a separate sheet.
TRADE OR
BUSINESS
NAME
BUSINESS
ADDRESS
CITY,
STATE &
ZIP
City
Village
Town
City
Village
Town
City
Village
Town
City
Village
Town
CITY,
VILLAGE,
OR TOWN
of:
of:
of:
of:
COUNTY
21. Name and address of financial institution through which you will maintain your business checking account.
Name
Account #
Street Address
City
State
Zip code
I declare under penalties of law that I have examined this information and to the best of my knowledge and belief, it is true, correct, and complete.
Signature (Must be signed by Proprietor, Partner, Member or Corporate Officer)
Social Security Number (Required for Sole
Proprietor)
Title
Date
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