(CONFIDENTIAL)
Complete and Mail or Fax to:
Applicant Complete This Box
City of Jacksonville
FEIN
ST of Ala Tax #
320 Church Avenue, SE
Form of Ownership (Check One)
Jacksonville, AL 36265
Sole Prop
Partnership
Corporation
Professional Assn.
(256) 435-7611
LLC
Other
Please Print or Type
SEE REVERSE SIDE FOR INSTRUCTIONS AND FURTHER INFORMATION
APPLICATION TYPE:
NEW
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)
Physical Address:
(Street)
(City)
(St)
(Zip)
Mailing Address:
(Street)
(City)
(St)
(Zip)
Telephone:
(Business)
(Fax)
(Home)
Name/Phone # for Contact Person:
(
)
List Names of Owner(s), Partners, or Officers (attach separate sheet if necessary)
Name
Residence Address
SSN
Title
Date Business Activity Initiated or Proposed
# of Employees
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
ACCOUNT ID #____________________ NAICS CODE______________ REVIEWED BY_________________________
PHYSICAL LOCATION:
CITY
POLICE JURISDICTION
OUTSIDE CORP LIMITS & PJ
ZONING CLASSIFICATION:__________________ BUILDING APPROVAL:
YES
NO
N/A
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
BUILDING CONTRACTOR
SERVICE
PROFESSIONAL
MANUFACTURER
RENTAL
OTHER_____________________