Business Registration

Business Information

Business Name	Atlantic Track & Turnout Company
Business Street Address (Including Unit or Suite, if applicable)	---
Mailing Address (If different than business street address above)	400 Broadacres Dr Ste 415, Bloomfield NJ 07003-3174
Business Phone	+18156784521
Business Fax	---
Email Address	---
Would you like to sign up for the Village E-Blast for current events and information?	---
Website Address	---

Business Owner Information

Business Owner(s) Name	---
Business Owner(s) Home Address	---
Business Owner(s) Phone Number (Home or Cellphone)	---

Is This A New Business?

Is This A New Business?

No, my business was registered under the same name prior to May 1st of this year.

Other Important Information

Illinois Sales and Use Tax and/or Retailers Occupation Tax	---
Operating Days	Monday, Tuesday, Wednesday, Thursday, Friday
Operating Hours	7-3:30
Number of Shifts	2
Number of Employees	51
Nature of Business	Manufacturing

Fueling Stations

Does your business have fueling stations on site?

Yes

Hoses

Number of gas hoses

1

Police Required Information

Burglar Alarm	Yes
Fire Alarm	Yes
Hazardous Materials	Yes

Burglar Alarm

Please Provide Additional Information	---
Monitoring Agency	---
Monitoring Agency Telephone Number	---
Alarm Type	---

Fire Alarm Information

Please Describe Alarm Box Location	---
Monitoring Agency	---
Monitoring Agency Telephone Number	---
Alarm Type	---

Hazardous Materials

Provide Detail Information

---

Emergency Contacts: Please provide 3 names/phone numbers of key holders who are available 24 hours in case of an emergency.

1) Name	Bruce Laubinger
1) Phone Number	+18159144908
2) Name	Jeremiah Grupe
2) Phone Number	+18153541629
3) Name	Jose Reyes
3) Phone Number	+18154516435

Late Fees

Was this submitted after May 22?

No

Prorated Fees

Was this submitted between August 1 - October 31?	No
Was this submitted between November 1 - January 31?	No
Was this submitted After February 1?	No

Certification Number

Certificate No

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