Transient Occupancy Tax
Registration Form
Accomack County, Virginia
(Separate application required for each location)
1.
Name of Business
2.
Owner
3.
Business Location
4.
Mailing Address
5.
Telephone Number:
6.
E-Mail Address:
7.
Business Type (Check one)
____ Motel/Hotel
____ Tourist Home
____ Campground
____ Other (Specify)
8.
Ownership Type (Check one)
____ Individual
____ Partnership
____ Corporation
9.
Name of Officials Signing if Corporation
10.
Months of Business Operation:
____ Yearly
____ Seasonal
(____/____/_____ to ____/____/_____)
11.
Name of Business Succeeding
The undersigned certifies that this information is true and accurate to the best of his/her knowledge.
Date
Signature
Title
1