Business Registration Application Form (Page 2 of 3) in pdf

Contact Phone:

CONTACT PERSON:

Contact Fax:

Contact E-mail:

TYPE OF ORGANIZATION (Ownership) – Please attach a copy of your charter

Individual

Partnership

Corporation

LLC

LLP

Non-Profit

Governmental

Other

Owner’s Name

IF an Individual:

Owner’s Address

(Attach valid photo ID)

Owner’s SS#

E-mail Address

IF a Corporation, LLC, LLP,

Officer / Manager /

or Partnership:

Partners Name

(Attach additional names if

Title

necessary)

Home Address

Telephone Number

Web Site

Agent for Service of Process:

Name

Address

This will affirm that the statements made herein are true and correct to the best of my knowledge:

Signature of Applicant or Owner

Title

Signature of Preparer

Date

Please make checks payable to Parish and City Treasurer

FOR OFFICE USE ONLY

LOCATION/DOMICILE (Circle One)

ACCOUNT TYPE (Circle One)

0001

City of Baton Rouge / EBR Sch Bd

FILING FREQUENCY

1520

Service/Rental/Etc.

0002

EBR Parish / EBR Sch Bd

M Monthy

1521

Airline

0003

City of Baker / Baker Sch Bd

Quarterly

1522

Travel Agency

0004

City of Zachary / Zachary Sch Bd

One Time Sale

1523

Nursing Home

0005

EBR Parish / Zachary Sch Bd

Irregular Filer

1525

Retail Dealer

0006

City of Baker / EBR Sch Bd

Annual (License Only)

1530

Retail Dealers In Motor Fuels

0007

City of Central / Central Sch Bd

1540

Pawn Broker

Retail Dealer – Institutional Consumers

0008

EBR Parish / Central Sch Bd

1601

0009

Outside EBR Parish

1610

Wholesale Dealer

0010

Outside Louisiana

CLASS (Circle One)

1611

Bulk Petro

Wholesale – Motor Vehicle

0100

Public Utility Only

1612

GROUP (Circle One)

0101

Public Utility / OLT

1622

Building Materials

0000

Not Assigned

0102

Public Utility / STX

1710

Finance

0001

Mall of Louisiana

0103

Public Utility / STX / OLT

1820

Commissioned Services

0002

Cortana Mall

0200

IPT

1822

Real Estate Broker

0003

Major Chemical & Manuf

0201

IPT / STX

2010

Investment Banking

0004

Hammond Aire

0300

HM / Rms

2020

Itinerant Vendor (Agricultural & Seafood)

0005

Downtown Development

0301

HM / Rms / STX

2021

Itinerant Vendor (Parades & Food Vendor)

0008

Perkins Rowe

0302

HM / Rms / STX / OLT

2022

Promoter

0009

Towne Center

0303

HM / Rms / STX / OLT / ABC

2023

Rolling Vendor

0304

2060

Special Events

0305

HM / STX

2070

Museum for Profit / Transient

CATEGORY (Circle One)

0400

Nursing Home / Rms

2090

Professional

0900

Walk-in Registration

0401

Nursing Home / Rms / STX

2640

Retail Autos

0901

Mail-in Registration

0500

Amusement Only

2710

Contractor

0902

Electronic Registration

0501

Amusement / STX

6000

Insurance Company

0903

Issue to Post

0502

Amusement / STX / OLT

7001

Public Utilities-Gross Receipts

0904

Revenue Inspector

0503

Amusement / STX / OLT / ABC

9999

No Occupational License

0905

Audit Registration

0600

STX Only

0906

File Conversion

0601

STX / OLT

Account Set Up By:

0602

STX / OLT / ABC

0700

OLT Only

Payment Received By:

Business Registration Application Form Page 2

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