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2. Applicant's Name
3. Email Address
5. Phone Number
7. Proposed Business Name
8. Estimated Opening Day for Business
   Estimated Opening Day for Business
10. Type of Business

    Briefly describe the business type.

12. Proposed Business Address
14. City
15. State
16. Zip Code
18. Is the mailing address different than the business address?

    1. No
    2. Yes
20. Mailing Address

    Complete the address fields below if the mailing address is different than the business address.

22. Mailing City
23. Mailing State
24. Mailing Zip Code
26. The information below may be utilized to generate an estimate for the Business License fee.
28. Estimated Gross Revenue for this Calendar Year
29. Estimated Worker Count for this Calendar Year

    Enter the estimated number of workers for this business (Use a factor of 0.5 for workers regularly scheduled to work less than 20 hours per week. For all other workers (who work 21+ hours per week) use 1.0 as the factor. For example, a business with 2 Full-time employees (working 21+ hours/week) and 2 Part-time employees (working < 20 hours per week) would need to enter 3.0 for the worker count).

31. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) I attest that, to the best of my knowledge and belief, all information in the above referenced data reported is accurate and complete.  2) you may still be required to provide a traditional signature at a later date. 

    1. I agree.
33. Electronic Signature
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field