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Applicant
Owner/Business Name*
Name of Person Completing Application*
Trading As Name*
Business Address
Street Number*
Direction
Street Name*
Street Type*
Suite
Floor
City
State
Zip Code*
Mailing Address
Address1*
Address2
City*
State*
Zip*
Additional Information
Email Address*
Business Phone*
Federal ID or Social Security*
Number*
Start Date in Norfolk (MM/DD/YYYY)*
Estimated Gross Receipts to December 31*
Description of Business Activity (Work performed, serviced provided)*
Describe how you will make your revenue (example: products sold, services rendered, commission, fees, etc).*
If application is a corporation, list officers and registered agent.
President
Secretary
Treasurer
Registered Agent and Contact Address
Agent Name
Agent Address