City Of Atmore, Al Business Application Form
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3CITY OF ATMORE, ALABAMA BUSINESS APPLICATION
(CONFIDENTIAL)
Complete and Mail
Applicant Complete This Box
TIN_____________________________
CITY OF ATMORE
ST of Ala Tax #____________________
Please Print or Type
P.O. DRAWER 1297
Form of Ownership (Check One)
SEE REVERSE SIDE FOR INSTRUCTIONS
ATMORE AL 36504
Sole Proprietor
Partnership
AND FURTHER INFORMATION
(251) 368-1841 (FAX)
Corporation
Professional Assoc.
(251) 368-2253
LLC
Other ____________
APPLICATION TYPE:
NEW
RENEWAL
OWNER CHANGE
NAME CHANGE
LOCATION CHANGE
Legal Business Name:
_____________________________________________________________________________________________
_________________________________________________________________________________________________________________
Trade Name: (If different from above) _____________________________________________________________________
____________________________________________________________________________________________________
Business Activities: (Brief description: - example, retail clothing sales, wholesale food sales, rental of industrial equip., computer consulting,
etc)
_________________________________________________________________________________________________________________
Physical Address: __________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Mailing Address: __________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Telephone: _______________________________________________________________________________________________________
(Business)
(Fax)
(Home Phone – In Case Of Emergency)
Email:
AlaTax Acct. #:
AlaTax Taxpayer Name:
Name/Phone # for Contact Person:
_________________________________________ (
) _________________________________
List Names of Owner(s), Partners, or Officers (Attach separate sheet if necessary)
Name
Residence Address
SSN
Title
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Date Business Activity Initiated or Proposed in ATMORE, ALABAMA: __________________________ # of Employees in ATMORE
______________
This application has been examined by me and is, to the best of my knowledge, a true and complete representation of the above named entity,
and person(s) listed.
Date __________________ Signature ______________________________________________
Title __________________________
THIS AREA FOR MUNICIPAL USE ONLY
ACCOUNT ID # __________________________
REVIEWED BY:_____________________
PHYSICAL LOCATION:
CITY
POLICE JURISDICTION
OUTSIDE CORP LIMITS & PJ
ZONING CLASSIFICATION: _____________________
BUILDING APPROVAL:
YES
NO
N/A
FIRE CODE
TAX TYPES:
SALES/SELLER'S USE
CONSUMER USE
RENTAL
LODGINGS
ALCOHOL
OCCUPATIONAL
TOBACCO
GAS/MOTOR FUEL
BUSINESS LICENSE
TAX FILING FREQUENCY:
MONTHLY
QUARTERLY
ANNUAL
OTHER ________________
BUSINESS TYPE:
RETAIL
WHOLESALE
BUILDING CONTRACTOR
SERVICE
PROFESSIONAL
MANUFACTURER
RENTAL
OTHER _______________________________________
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Parent category: Business