PRIVILEGE (BUSINESS) LICENSE APPLICATION FOR COLBERT COUNTY

NAME OF BUSINESS: ___________________________________________________

DBA NAME:____________________________________________________________

LOCATION OF BUSINESS: _______________________________________________

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MAILING ADDRESS (if different): _________________________________________

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OWNERS NAME: ______________________________________________________

MANAGERS NAME: ____________________________________________________

OWNERS HOME PHONE NUMBER: _____________________________________

OWNERS BUSINESS PHONE NUMBER: __________________________________

OWNERS FEDERAL ID NUMBER: _______________________________________

OWNERS SOCIAL SECURITY NUMBER: _________________________________

OFFICERS OF CORP:

PRESIDENT:________________________________________________________

VICE PRESIDENT: __________________________________________________

DESCRIPTION OF BUSINESS: ____________________________________________

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NAME OF PERSON FILLING OUT THIS FORM:

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