Name of Applicant

Your Email

 New Application Renewal

Name of Business

Mailing Address

City

State

ZipCode

Local Address

Type of Merchant

WholesaleRetailPeddler

Type of Business

The following information must be furnished before the license will be issued:

Choose Business Organization

IndividualPartnershipCorporation

If Individual or Partnership, list names and addresses below. If Corporation, list the names and addresses of the President and Secretary below.

A

B

Phone Number

Alternate Phone Number

Name of Business Manager

List Any Other Names Used

List the Names and Addresses of Any Other Business You Own or are Associated With

If New Business, State the Exact Date Operation Began

Name of Previous Business Located at This Address

Number of employees, Part-Time and Full-Time (including owner), as of July 1st

If contractor, list NC License Number

If restaurant, List No. of Seats

If hotel or motel, List No. of Rooms

If manufacturing, List No. of Employees

If manufacturing or assembling of any item or commodity/tax based on number of employees including office and owners.

“By signing this application, it is understood that the applicant that the issuance of a privilege license hereunder does not constitute acceptance or approval of the use of the above named location as having compiled with existing zoning regulations, building codes and/or fire protection code. A Licensee shall remain fully liable and responsible for bringing the premises in conformity with all applicable City and State Codes.”
I solemnly swear or confirm that the statements made in the foregoing application are true to the best of my knowledge and belief.