Application For Business License Form - Birmingham - Alabama
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1
2Application for Business License
City of
Make Check Payable To:
(
)
ALL FIELDS MUST BE COMPLETED
Tax Trust Account
Due: January 1, 2010
Mail to:
Delq: February 1, 2010
See Reverse Side for Instructions
RDS
And Further Information
Business License Dept.
2010
PO Box 830725
Business License Application
Birmingham, Alabama 35283
Fax Number 205-423-4099
Application Type:
Renewal
New Business
Name Change
Owner Change
Location Change
Form of Ownership (Check One):
Sole Prop
Corp
LLC
Partnership
Professional Assoc
Other _____________________
RDS Acct Number ____________Date Business Activity Initiated/Proposed: __________ Number of Employees: ___________
Legal Business Name: _____________________________________ FEIN/Social Security #____________________________________
Trade Name / DBA:
__________________________________________ (If different from legal name.)
Business Type:
Retail
Wholesale
Bldg Contractor
Service
Professional
Manufacturer
Rental
Other ________________________Describe Business You Are Conducting ________________________________
Mailing Address: _________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Physical Address: ________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Telephone:
___________________________________________________________________________________________________________________
(Business)
(Home)
(Cell)
(Fax)
Name/Phone # for Contact Person:
Title
_______________________________ (
) _______________________
____________________________
List Names of Owners(s), Partners, or Officers (Attach Separate Sheets if Necessary)
Name
Residence Address
SSN
Title
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
*Police Jurisdiction: The area outside the incorporated municipality limits. 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 this box
if you are in the
police jurisdiction.
Column
Column
Column
Column
Column
Column
Column
A
B
C
D
E
F
G
Unit Amount
(Applies if fee is
Section
Gross Receipts
Additional Amount Due
Type of License
Flat/Base Fee
License Fee Due
based upon a
(If Required)
Number
Based On Calculation
“number” of
units)
Report all types of business conducted
Add column E & F enter total in column G then add down
15% Penalty Due Feb 1st plus 1% interest, Additional 15% Penalty Due March 2 plus 1% Interest per
Penalty Info:
month thereafter
Issuance Fee:
$ 10.00
Total Due:
To determine license fee due see a full schedule listing at
or you may call our Business License Department with
any questions at 800-556-7274 select option 1, then 6 then 1.
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 ____________________________________Title: _____________________
Print Name: _____________________________________ Telephone Number: _________________________________________________
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