Form R-1 - Business Registration Form Page 3
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8Savings and Loan – An entity as defined in Section 6.1-194.2 of the Code of Virginia authorized to accept
deposits and to hold itself out to the public as engaged in the savings institution business (such as a Savings
and Loan Association, a Building and Loan Association, Building Association, Savings Bank).
Public Service Corporation - An entity that conducts a business of a public service nature as defined in Section
58.1-2600 and Section 13.1-620 of the Code of Virginia.
Government Entities
Federal Government
Virginia State Government
Virginia Local Government
Other Government
4.
Trading As Name (or Doing Business as Name)
_____________________________________________
This is the name that would be known to the public.
5.
Sole Proprietor (if applicable):
Owner’s Name
___________________________________________
Owner’s SSN
___________________________________________
6.
Primary Business Activity
______________________________________________________________
Describe the specific product line or service your business provides.
Check if you will be selling any tobacco products?
7.
Primary Business Address - Enter the physical address of your business.
Street Address
_________________________________________________________________
City
__________________________
State ______
ZIP Code ______________
8.
Primary Mailing Address – enter a mailing address if different from your Primary Business Address.
Address or PO Box ______________________________________________________________
City
__________________________
State ______
ZIP Code ______________
9.
Primary Business Contact Information – identify the contact person most knowledgeable about your business.
Name
____________________________________
Phone Number
_______________________
Fax Number ________________________
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Parent category: Financial