Business License Application

Name of Business

Business Address

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (if different)

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (if different) (copy)

Address Line 1

Address Line 2

City

State

Zip Code

Email

Confirm Email

Business Phone

Emergency Phone

Name of Applicant

Local Contact Name & Phone

(Short-term Rental business if owner is not Washington County resident)

Specify Business to be Conducted

Business Is:

Corporation
Sole Proprietorship
Limited Liability Company (LLC)
Partnership

Dept. of Commerce Entity #

DOPL License # (if applicable)

Federal Tax ID#

Sales Tax # (Attach Copy)

List All Owners other than Applicant

Required to be licensed by state?

Yes

Attach Copy of State License

Click or drag a file to this area to upload.

Copy of Driver’s License or Proof of Identity

Click or drag a file to this area to upload.

Will tobacco products be sold at business?

Yes
No

Is this a Sexually Oriented Business?

Yes
No

List Any Other Business Owned by Applicant

Signature

Clear Signature

Title

Application Completed By

Authorized Applicant Signature

Clear Signature

City Hall Hours

Justice Court Hours

After Hours Emergency