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Revenue Department
275 N Union Avenue
PO Box 1987
Ozark, Alabama  36361
PHONE: (334) 774-5262
FAX: (334) 445-1054

BUSINESS LICENSE APPLICATION
(CONFIDENTIAL)

 

APPLICATION TYPE:
TYPE OF LICENSE:
BUSINESS ORGANIZATION:
LEGAL BUSINESS NAME / DBA:*
PHYSICAL ADDRESS*
MAILING ADDRESS:*
TELEPHONE:*
EMAIL ADDRESS:
BUSINESS ACTIVITIES: (Example- Contractor / Sub or General, Retail / Clothing Sales, Wholesale Foods, Equip. Rental, Computer Consulting, etc)*
ALATAX ACCOUNT #
ALATAX TAXPAYER NAME:
STATE CERTIFICATE #: (Required for Automobile Dealer, Beautification, Electrician, General Contractor, Heating / AC Installer, Landscape, Homebuilder / Remodeler, Pawn Shop, and Pest Control)
SALES TAX #:
COMPETENCY CARD #: (Required for Plumbers and Plumbing Contractors)
HEALTH DEPT PERMIT #: (Required for food services)
FED TAX ID OR SOCIAL SECURITY NUMBER:*
CONTACT PERSON NAME:*
CONTACT PERSON PHONE:*
CONTACT PERSON EMAIL:
LIST NAMES OF OWNER(S), PARTNER, OR OFFICERS
NAME / TITLE:*
RESIDENCE ADDRESS (Include City, State, and Zip Code)*
SSN / DLN*
NAME / TITLE:
RESIDENCE ADDRESS
SSN / DLN
NAME / TITLE
RESIDENCE ADDRESS
SSN / DLN
DATE BUSINESS ACTIVITY INITIATED OR PROPOSED IN OZARK, AL:
# OF EMPLOYEES IN OZARK, AL:

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 persons listed.

Emergency Contact Name
Emergency Contact Phone Number
DATE:*
PERSON SUBMITTING:*
TITLE:

SHOULD THERE BE ANY QUESTIONS CONCERNING THE COMPLETION OF THIS FORM OR THE LICENSING AND/OR REGISTRATION PROCESS, PLEASE CALL 334-774-5262 OR EMAIL revenue@ozarkalabama.us TO OBTAIN A MORE DETAILED EXPLANATION.

 

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*Required