City Of Robertsdale, Al Business Application Form
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1CITY OF ROBERTSDALE, ALABAMA
BUSINESS APPLICATION
(CONFIDENTIAL)
Complete and Mail to
Applicant Complete This Box
City of Robertsdale, Revenue Dept.
FEIN_______________________________
Please Print or Type
P.O. Box 429
AL Dept of Revenue #_________________
SEE REVERSE SIDE FOR INSTRUCTIONS
Robertsdale, AL 36567-0429
Alabama Regulatory Lic # _____________
AND FURTHER INFORMATION
(251) 947-8920 FAX (251) 947-1129
Form of Ownership (Check One)
TDD (251) 947-2122
Sole Proprietor
Partnership
Corporation
Professional Assoc.
Date of Application:
LLC
Other _________________
_________________
APPLICATION TYPE:
NEW
RENEWAL
OWNER CHANGE
NAME CHANGE
LOCATION CHANGE
Legal Business Name:
_____________________________________________________________________________________________
Trade Name: (If different from above)______________________________________________________________________
Business Activities:
(Brief description - example. retail clothing sales, wholesale food sales, rental of industrial equip., computer consulting,
etc)
Activity:
Product:
If you make deliveries or sales into the City’s Taxing Jurisdiction, indicate the method: Sales__________________ Delivery _____________
Physical Address: __________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Mailing Address: __________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Telephone: _______________________________________________________________________________________________________
( Business)
(Fax)
(Home Phone – In Case Of Emergency )
Email:
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__
Annual Anticipated Gross Receipts or Gross Receipts for the preceeding year: $_______________
Date Business Activity Initiated or Proposed in ROBERTSDALE:_________________________ # of Employees in Robertsdale _____________
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.
Date __________________ Signature ______________________________________________
Title __________________________
THIS AREA FOR MUNICIPAL USE ONLY
Robertsdale ACCOUNT # __________________________
REVIEWED BY: _____________________
PHYSICAL LOCATION:
CITY
POLICE JURISDICTION
OUTSIDE CORP LIMITS & PJ
ZONING CLASSIFICATION: _______________
BUILDING APPROVAL:
YES
NO
N/A ______ <INITITALS>_______ FIRE CODE
TAX TYPES:
SALES/SELLER'S USE
CONSUMER USE
RENTAL
LODGINGS
ALCOHOL ____________________________
OCCUPATIONAL
TOBACCO
GAS/MOTOR FUEL
BUSINESS LICENSE
TAX FILING FREQUENCY:
MONTHLY
QUARTERLY
ANNUAL
OTHER ________________
BUSINESS TYPE:
RETAIL
WHOLESALE
CONTRACTOR
SERVICE
PROFESSIONAL
MANUFACTURER
RENTAL
OTHER _________________________________
NAICS CODE(S) ________________________________
State of Alabama Regulatory Agency & License #________________________
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Parent category: Financial