Business License Application

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Business License Application
_Select One
Municipality Name: __________________________
Dates--Due:
Delinquent:
_Select One
Online Filing is Available
Application Type:_____________
U
Free-Fast-Secure-Step by Step
Current Year (License Year):
_Select One
Ownership Type:
U
2016
___________
_Select One
Purchasing different license year, indicate year:
Business Type: _______________
All Fields Must Be Completed
___________________________________________
RDS Account No.: ____________
Date Business Activity Initiated/Proposed:
NAICS: ____________
Instructions:
___________________________________________
All municipalities are required to obtain a copy of individual/entities board certifications/permits prior to issuance of a business license. For a list
of certifications, please visit our website here.
To determine license fee due see a full schedule listing at
or email our Business License Department at
with any questions or call 800-556-7274. Fax documentation toll free to 844-528-6529.
Federal Employer Identification No. (FEIN): ___________________ Social Security No.:__________________ Number of Employees: __________
Describe Business Conducted: ________________________________________________________________________________________________
Legal Business Name: ________________________________________________________________________________________________________
(If different from legal name)
Trade Name / DBA: ________________________________________________________________Email: _____________________________________
Mailing Address:
_______________________________________________________________________City:_________________________State:_____Zip:___________
Physical Address:
_______________________________________________________________________City:_________________________State:_____Zip:___________
(No PO Box Allowed)
Telephone Numbers: Business: __________________Home: ____________________Cell: ____________________ Fax: ________________________
Contact Person Name: _____________________________________________Phone:_____________________Title:_____________________________
List Names of Owner(s), Partner(s), or Officer(s)-Attach Separate Sheet if Necessary:
Name:
Residence Address:
SSN:
Title:
____________________________ ___________________________________________ ______________ ________________________
____________________________ ___________________________________________ ______________ ________________________
Police Jurisdiction Definition: The area outside of the incorporated municipality limits as defined by local ordinance. Businesses physically located
in the police jurisdiction are subject to purchase a business license per the municipality’s ordinance at one-half the normal rate, if applicable.
Please check the box if you are in the police jurisdiction but not in the incorporated city limit.
Column A
Column B
Column C
Column D
Column E
Column F
Column G
Units Required if Fee is based upon a
Add Column E & F. Enter Total in Column G and then add
Report all types of business conducted
“number” of units ie. days, machines, etc.
down for Total Due.
Schedule
Flat/Base
Additional Amount Due
License Fee
Type of License
Gross Receipts
Unit Amount
No. #/ Code
Fee
Based on Calculation
Due
$
$
$
Penalty Information:
$
Calculate Penalty (if applicable):
$
Calculate Interest (if applicable):
$
Issuance Fee:
$
Total Due:
Make Check Payable To: Tax Trust Account
Mail To: RDS Business License Dept.
PO Box 830900
Birmingham, Alabama 35283-0900
Sworn Statement: I hereby swear that the amount of capital invested or value of goods, stocks, furniture and fixtures or amount of sales or receipts as required for
disclosure in order to obtain a business license has been examined by me and to the best of my knowledge is true, correct, and complete. I understand
issuance of license does not permit business operation unless business is properly zoned, and/or in compliance with all applicable laws/rules.
Signature: _____________________________________________ Date: _________________ Telephone No.:___________________
Print Name:____________________________________________________ Title:__________________________________________
Email: _______________________________________________________________________________________________________
Returned Check Disclaimer: Effective July 1, 2010, each returned item received by RDS due to insufficient funds will be electronically represented to the presenters’ bank no
more than two times in an effort to obtain payment. RDS is not responsible for any additional bank fees that will accrue due to the resubmission of the returned item. Please see
the full returned check policy at /taxpayer/return-check-disclaimer.

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