Section A

1. Business Name:



2. Local Business Address (No P.O. Box Numbers Allowed):


City: State: Zip:


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:


4. Email Address:


5. Website Address:

Section B

Check One:

Name:

Title:

Address:

City: State: Zip:


Name:

Title:

Address:

City: State: Zip:


Business Phone:

Contact Name:

Contact Phone:

Manager Name:

Manager Phone:

Does the firm own the building?

Date Business started in Greensboro:

Number of Employees at this location:
Full TimePart Time

Fiscal Year Ends:

Certified M/WBE

Section C

Please describe your business activities.


Section D

Check each activity that applies to your business:

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.

Anyone who submits a form should be aware that in accordance with the North Carolina Public Records law, found in North Carolina General Statutes Chapter 132, his or her e-mail address is considered public record.