Section A
1. Business Name:
2. Local Business Address
(No P.O. Box Numbers Allowed)
:
*
City:
State:
Zip:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
D.C.
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
3. Mailing Address
(Only if different than above; P.O. Box Numbers
are
allowed here. If mailing address is the same as above, enter
"same"
below):
*
City:
State:
Zip:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
D.C.
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
4. Email Address:
5. Website Address:
Section B
Check One:
Individual (List Names and Addresses Below)
Partnership (List Names and Addresses Below)
Corporation (List President's and Secretary's Names and Home Addresses Below)
LLC (List President's and Secretary's Names and Home Addresses Below)
Name:
Title:
Address:
City:
State:
Zip:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
D.C.
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Name:
Title:
Address:
City:
State:
Zip:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
D.C.
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Business Phone:
*
Contact Name:
*
Contact Phone:
*
Manager Name:
*
Manager Phone:
*
Does the firm own the building?
Yes
No
Date Business started in Greensboro:
*
Number of Employees at this location:
Full Time
Part Time
Fiscal Year Ends:
Certified M/WBE
Yes
No
Section C
Please describe your business activities.
*
Section D
Check each activity that applies to your business:
Panhandler
Peddler
Itinerant Merchant
Mobile Food Vendor
Solicitor
Street Performer
Massage Business
Adult Business
Other (Please Describe Above)
Special Note:
It is understood by the applicant that issuance of a business permit does not constitute acceptance or approval of the use of the named location as having complied with existing building, zoning or fire prevention codes. The business shall remain fully liable and responsible for bringing the premises into conformity with all applicable city and state codes.