Section A

1. Business Name:



2. Local Business Address (No P.O. Box Numbers Allowed):


City: State: Zip:


3. Mailing Address (Only if different than above; P.O. Box Numbers are allowed here. If mailing address is the same as above, enter "same" below):  

City: State: Zip:


4. Email Address:


5. Website Address:

Section B

Check One:



Name:

Title:

Address:

City: State: Zip:


Name:

Title:

Address:

City: State: Zip:


Business Phone:

Contact Name:

Contact Phone:

Does the firm own the building?

Date Business started in Greensboro:

No. Employees at this location:

Fiscal Year Ends:

Publish on City Website:

Section C

Please describe your business activities.


Section D

Check each activity that applies to your business:









Special Note:

It is understood by the applicant that issuance of a privilege license does not constitute acceptance or approval of the use of the named location as having complied with existing building, zoning or fire prevention codes.   A licensee shall remain fully liable and responsible for bringing the premises into conformity with all applicable city and state codes.

Anyone who submits a form should be aware that in accordance with the North Carolina Public Records law, found in North Carolina General Statutes Chapter 132, his or her e-mail address is considered public record.