Business Application - City Of Robertsdale, Alabama
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1BUSINESS APPLICATION
CITY OF ROBERTSDALE, ALABAMA
(Confidential)
Print or Type this Form
LICENSE TYPE:
NEW
RENEWAL
OWNER CHANGE
NAME CHANGE
LOCATION CHANGE
TAX TYPE:
SALES
SELLERS USE
CONSUMER USE
RENTAL
LODGING
TOBACCO
GAS/MOTOR FUEL
ALCOHOL (beer, wine, liquor)__________________
Legal Business Name: _________________________
_________________________________________________________________
Doing Business As (if different from above): _________________________________________________________________
MAIL TO:
Federal Tax ID (FEIN) _______________________________________
Alabama Department of Revenue Tax ID #_______________________
City of Robertsdale, Revenue Department
Alabama Regulatory Board: ___________________________________
P.O. Box 429
↓
Robertsdale, AL 36567-0429
License # __________ → Expiration Date: _____________
Board
Contact Numbers: Office (251) 947-8920
FAX (251) 947-1129 TDD (251) 947-2122
Form of Ownership (Check One)
E-mail:
Sole Proprietor
General Partnership
Website:
Corporation
Professional Association
Physical Address: 22647 Racine Street
LLC
Other (specify) __________________
Robertsdale, AL 36567-6735
Business Activity & Product:
(Write a brief description – example: retail sales, wholesale sales, rental of tangible personal property, computer consulting)
________________________________________________________________________________________________________________
_______________________________________________________________________________________
If you make deliveries or sales into the city limits or police jurisdiction, indicate how you make the sale and how the product is delivered:
Sales Method: _______________________________________
Delivery Method: _____________________________________________
PHYSICAL LOCATION:
CITY LIMITS
POLICE JURISDICTION (PJ)
OUTSIDE CTIY LIMITS & PJ
Physical Address: __________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Mailing Address: __________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Telephone: _______________________________________________________________________________________________________
(Business)
(Fax)
(Home Phone – In Case Of Emergency)
E-mail Address:
Name/Phone Number for Contact Person:
__________________________________________________ (
)___________________
List Names of Owner(s), Partners or Officers (attach separate sheet if necessary)
Name
Residence Address
SSN
Title
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Are hazardous materials used at this location? Yes ____ or No ____
Coin-Operated Vending Machines at this location? Yes___ (#____) or No___ Machine Owner(s): ___________________________________
Date business activity initiated or proposed to be initiated in ROBERTSDALE:
____________________
Annual anticipated Gross Receipts (if new business) or Gross Receipts for the preceding year:
$ ________________________
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This application has been examined by me and is to the best of my knowledge a true and complete representation of the above named entity
and person(s) listed. I am authorized to sign legal documents.
Date __________________ Signature ______________________________________________
Title __________________________
(Owner/Partner/Member/Officer/Power of Attorney Representative)
Business Application COR Revised 09-2015
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Parent category: Business