Print Form
Basic Business License
Application
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Applicant:
Please read instructions carefully before you complete this
Vietnamese
Amharic
Korean
Customer Number
application.
______________________
Other
SECTION A: BUSINESS / APPLICANT INFORMATION
Check box
applicable to your business organization:
Sole Proprietorship
Partnership
Limited Liability Company
Corporation (For Profit)
Corporation (Non-Profit)
1. Business Owner (If owner is Sole Proprietor, print his/her name. If owner is Corporation, Limited Liability Company (LLC), or Partnership, print official Company Name to be
licensed) ……………………………………………………………………………………………………………………………………………………………………
1a. Federal ID No.
Federal Employer Identification Number (FEIN)…………………………………………………………………………or if your business does not have a FEIN number,
give your Social Security Number (SSN) …………………………………………………………………………………………
1b. Trade Name if applicable (see Instructions)
………………………………………………………………………………………………………………………………………………………
2. Business Address (If this is a Corporation, LLC or Partnership, please provide address of the company’s main headquarters here)
2a. Street Address ……………………………………………………………………………………………………………… Suite or Apartment No. ………………
2c. City ……………………………………………………………………………….. State …………………………………….. Zip ……………………………
…………….……………………………………………………………….
2d. Phone number (
) …………………………………………
2e. Email
SECTION A-1: OFFICERS, PARTNERS, MEMBERS
All Corporations, Partnerships, LLCs, and Unincorporated Associations must complete
3.
President / Partner / Member:
3a. Name ………………………………………………………… ………………… …………………………………………………………………………………
First Name
M.I.
Last Name
……
3b. Street Address ………………………………………………………………………………………………………………………………………………
3c. City ……………………………………………………………. State ……………………………………………………. Zip ………………………………….
.
3d. Phone (
) ………………………………………...…
3e. Email ………..…………………………………………………………..
4.
Vice President / Partner / Member:
4a. Name ……………………………………………………….. …………. ………………………………………………………………………………………
First Name
M.I.
Last Name
4b. Street Address …………………………………………………….………………………………………………………………………………………………………………
………………………………….
4c. City ……………………………………………………….….……………. State ……………………………………………………. Zip
…………………………………………………………………………..
4d. Phone (
) ……………………………..………..………. 4e. Email
5.
Secretary / Treasurer / Member:
5a. Name …………………………………………………………….. …………. ……………………………………………………………………………………
First Name
M.I.
Last Name
5b. Street Address …………………………………………………………………………………………………………………………………………………………………………
5c. City …………………………………………………………………………………. State ……………………………………………………. Zip ………………………………
.
)
5d
Phone (
………………………………………………. 5e. Email .………………………………………….………………………………..
SECTION B: INFORMATION ABOUT BUSINESS PREMISE ADDRESS (Vendors: skip this section)
Location of business operation to be licensed.
6. Street Address ………………………………………………………………………………………..…………………….
Suite or Apt No. ….…………
City …………………………………………………………………….… State …………………………………………………… Zip …………………………..
6a. Quadrant (check one)
NE
NW
SE
SW
6b. Ward ……………………….
6c. ANC ……………………………………………
6d. Phone (
) …………………………………………………………
6e. Fax No.………………………………………………………..
6f.
Email …………………………………………………………..………………………………………………………………………………………….
6g. Certificate of Occupancy Number: ……………………………………………..
Date Issued ………………………….
Department of Consumer & Regulatory Affairs ♦ 941 North Capitol St NE
Washington DC 20002 ♦ (202) 442-4311 ♦ Fax (202) 442- 4523 ♦ For Relay Service dial 711
dcra.dc.gov
bbl.infocenter@dc.gov
Website:
Email:
♦
1-1-07