Business License Application

Start Date:

MonthDayYear
Date
Please fill in all that apply:
List address below where each individual consents to recieve service of process (business license) per AB2184 Sec. 16000 1(a) (2) and 16100 1(a) (2)
Service of Process Address:*

Street Address

exp. Unit/Suite/NA

CityState / Province

Postal / Zip Code
Fill in fields if mailing address is different from the Service of Process Address/Business Address:
Type of Business:

RETAILSUB CONTRACTORSEMI-PROFESSIONALWAREHOUSE ONLYNON PROFIT ORGANIZATIONENTERTAINMENT/AMUSEMENTWHOLESALEOWNER/BUILDER/DEVELOPERMANUFACTURINGHANDBILL DISTRIBUTIONADMINISTRATIVE HEADQUARTERSDELIVERY VEHICLEGENERAL CONTRACTORPROFESSIONALPROPERTY RENTALFLAT RATES,MISC.Other
DESCRIPTION OF BUSINESS:*
Exempt*

YesNo
Home Occupation*

YesNo
OWNERSHIP: (Please check below)
NOT PUBLIC INFORMATION*

CorporationLtd Liability CorpGeneral PartnershipLtd Limited PartnershipSole Proprietorship
Sole proprietorship, Partners or Corporate Officers: (If different from the Service of Process Address/Business Address)*
Please call for business tax due.

Business Tax Due: BLTAXN _________
*State Mandated Fee: BLSTF $4.00
Registration Application Fee: BLNEW $125.00

Total : _________
BY MY ELECTRONIC SIGNATURE BELOW I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
Electronic Signature:*

Name Title
Date*

MonthDayYear
Under federal and state law, compliance with disability access laws is a serious and significant responsibility that applies to all California building owners and tenants with buildings open to the public. You may obtain information about your legal obligations and how to comply with disability access laws at the following agencies:
- The Division of the State Architect at www.dgs.ca.gov/dsa
- The Department of Rehabilitation at www.dor.ca.gov
- The California Commission on Disability Access at www.ccda.ca.gov
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