Home Occupancy Application
Jan 17, 2023
submission
#563
Business License Application
Business Name and Physical Location
| Business Name or Trade Name | Fast RXV |
| Business Street Address (Physical location of the business cannot be a PO Box) | --- |
| Mailing Address (Street name and number only) | --- |
| Mailing Address City, State, & Zip Code | --- |
| Business Phone Number | +19284269077 |
| Alternate # (Emergency Phone Number) | --- |
| Number of Employees | --- |
| Please read trough the list carefully and select the closest description of your business: | HOME OCCUPANCY OFFICE |
| Business Description (Please describe in detail the nature of the business) | --- |
| Start of business date | 2023-02-06 |
| is the business location: | --- |
| Nature of Ownership | --- |
Individual/ Sole Proprietor Owner Information (Eligibility Form)
| Name (First and Last) | --- |
| Title | --- |
| Home street address (cannot be a PO Box) | --- |
| Social Security Number (Last four (4) digits only) | --- |
| Phone Number | --- |
| *Check the box next to the document you are presenting to the Town, indicating lawful presence | --- |
| Attach a copy of said document | --- |