Vending License Application Form

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VENDING LICENSE APPLICATION FORM
Office Use Only: Application #:
Application Information:
New
Renewal
____________________
________________________________
______________________
Date
Business Register/Vendor ID#
Trader ID#
Applicant:
Mr.
Mrs.
Ms.
Other _____________________________
___________________________
______________________________
________________
Last Name
First Name
Middle Initials
__________________________________________________________________________________
Residential Address
Parish
Postal Code
__________________________________________________________________________________
Mailing Address (if different from above)
Parish
Postal Code
_________________________
_______________________
______________________
Home Telephone
Work Telephone
Cell Number
___________________
______________
_______________
______________________
Email Address
Date of Birth
ID Type
ID Number
Bermudian
Yes
No
If No, Nationality _________________________
_________________________
_________________________
______________________
Vending Business Name
Vending Business Contact #
Vending Business Email
________________________________________________________
______________________
Vending Business Physical Location/Address
Years in Business
Sofia House, First Floor, 48 Church Street, Hamilton, HM12 Bermuda | P.O. Box HM 637 Hamilton HMCX
Telephone 441-292-5570 | Fax 441-295-1600 | Email info@bedc.bm | Web

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