Business Registration/mercantile License Application printable pdf download

Tax forms and other information available at

TRI-STATE FINANCIAL GROUP, LLC

PO BOX 38

Phone 610-993-8609

BRIDGEPORT, PA 19405

Fax

610-889-9427

BUSINESS REGISTRATION/MERCANTILE LICENSE APPLICATION



ANSWER ALL QUESTIONS COMPLETELY. INCOMPLETE APPLICATIONS WILL NOT BE APPROVED



A SEPARATE APPLICATION MUST BE FILED FOR EACH COMPANY DOING BUSINESS

__________________________________________________

BUSINESS NAME (Enter name under which business is conducted):

COMPLETE ADDRESS OF ACTUAL BUSINESS LOCATION IN BETHLEHEM CITY (No PO Boxes, if none, write NONE):

___________________________________________________________________________________________________________________

EIN / SSN: ________________________________________________________

MAILING ADDRESS (If different than above):

_______________________________________________________________________________________________________

ADDRESS OF CORPORATE OFFICE:

_______________________________________________________________________________________________________

PHONE NUMBERS: Local office (______)__________________________ Corporate Office (_____)_____________________

DESCRIPTION OF BUSINESS ACTIVITY ___________________________________________________________________

DOES THIS BUSINESS HAVE OTHER LOCATIONS: ( ) Yes ( ) No If YES , where are the other business locations:

( ) In Pennsylvania

( ) Other __________________________________________________________________________

BUSINESS TYPE: ( ) Sole Proprietorship ( ) Partnership ( ) C Corp ( ) S Corp ( ) LLC ( ) Non-Profit

10. DATE STARTED IN BETHLEHEM CITY: _________________________

11. NUMBER OF EMPLOYEES AT THIS LOCATION: (Including self-employed, partners and owners) _____________________

12. DO YOU RENT THE OFFICE SPACE OF BUILDING YOU OCCUPY? ( ) Yes ( ) No If YES, give name and address of

landlord or rental agent ____________________________________________________________________________________

13. IS THIS BUSINESS A: ( ) Retail ( ) Wholesale ( ) Service ( ) Rental Income ( ) Manufacturer

14. DO YOU OWN ANY PROPERTY IN BETHLEHEM CITY FOR WHICH YOU RECEIVE RENTAL INCOME?

( ) Yes ( ) No If YES, give name of owner or rental agent ____________________________________________________

15. ARE THERE ANY LEASED DEPARTMENTS OR CONCESSIONAIRES AT THIS LOCATION? ( ) Yes ( ) No

If YES, please provide name and address of provider ____________________________________________________________

16. ARE THERE ANY SUB-CONTRACTORS PERFORMING SERVICES ON YOUR BEHALF IN CITY? ( ) Yes ( ) No

If YES, please provide name and address of sub-contractor _______________________________________________________

**All businesses and/or employers in the City of Bethlehem are required to register with the

Tri-State Financial Group. A Registration Fee of $25.00 must accompany this Registration Form**

TOTAL AMOUNT DUE WITH APPLICATION

$ ____25.00_____

Enclose check made payable to “CITY OF BETHLEHEM” –

Mail to Tri-State Financial Group, PO Box 38, Bridgeport, PA 19405

Print Name (Owner or Authorized Person): ________________________________________________

Date __________________

Signature (Owner or Authorized Person): __________________________________________________ Title ___________________

Business Registration/mercantile License Application

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