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2. 
4. Business Tax Receipt Application
   PLEASE NOTE THAT NEW APPLICATIONS MAY TAKE UP TO TWO WEEKS TO PROCESS. OUR OFFICE WILL CONTACT YOU AFTER YOUR APPLICATION HAS BEEN REVIEW FOR PAYMENT INFORMATION OR ANY ADDITIONAL INFORMATION NEEDED.
6. Business Name*
7. Owner's Name
9. Type of Business*
   -- Select One --CorporationPartnershipIndividual

   Please choose one
10. License Type of Business*
    -- Select One --AGENCIES/BROKERSAUTOMOBILE DEALERBANKING/LENDINGCOSMETOLOGYFAITH-BASED ORGANIZATIONCOMMUNICATIONS SERVICESCONTRACTORENTERTAINMENTEXHIBITION FACILITYGAS COMPANYGASOLINE/FILLING STATIONSINSURANCEJUNK SHOPLAUNDRY/DRY CLEANERSMERCHANTPROFESSIONALSRENTAL UNITSRESTAURANTS/MOBILE FOODSCHOOLSSERVICESTAXICAB COMPANYVENDING MACHINE COMPANYUNCLASSIFIED (SEE NEXT SECTION)

    PLEASE USE THE DROP DOWN TO SELECT THE LICENSE TYPE THAT BEST DESCRIBES THE TYPE OF BUSINESS
12. UNCLASSIFIED
    IF YOU CHOSE UNCLASSIFIED, PLEASE GIVE A BRIEF DESCRIPTION OF THE BUSINESS TYPE
14. Business Location *
16. City
17. State
18. Zip Code
20. Business Phone Number
21. Business Email Address
22. Business Fax Number
24. City
25. State
26. Zip Code
28. Mailing Address (if Different from above)
30. City
31. State
32. Zip Code
34. Phone Number (if Different from above)
35. Email Address (if different from above)
37. Federal Employer Identification Number
40. Is this Business Regulated by any state agency?*
    -- Select One --Yes (please provide a copy of your active State Certificate, Registration or License)No
41. State Regulation Information
    Please upload any information on State Certificates, Registrations, or Licenses.
43. Type of Business*
    -- Select One --CommercialHome Occupation

    Please Choose all that apply
44. Fire Inspections
    Fire Inspections

    If this a new business, follow this link to schedule a Fire Inspection.
46. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) You certify that your are empowered to execute this application and your signature on this written declaration has the same legal effect as an oath or affirmation. 2) You certify that you will abide by the terms and conditions imposed by the Codes of the City of Crestview 3) You Certify that the information provided is true and correct to the best of your knowledge 4) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
48. Electronic Signature*
49. Date
    Date

    Date
51. Title
53. Other Information
    An Fire Inspection may be required on your business. Our office will contact you if that is the case with a link to the form and contact information for the City of Crestview Fire Prevention Department.
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field