Business License Application
Business License Status
| What would you like to do today: |
---
|
| Is this a: |
---
|
| If you are are applying for or renewing a PV liquor License, please select which Series you are applying for |
---
|
Business Name and Physical Location
| Business name or Trade Name |
Biz Clean Pros
|
| Nature of Ownership |
---
|
| Business Street Address (Physical location of the business in the Town of Prescott Valley (cannot be a PO Box) |
600 S State Route 69 #1
|
| is the business location: |
---
|
| Mailing Address (Street name and number only) |
12420 E .Kachina Pl. #267
|
| Mailing Address City, State, & Zip Code |
Dewey Az 86327
|
| Business Phone Number |
+19285838706
|
| Number of Employees |
---
|
| Please choose the most applicable to your business: |
---
|
| Please read carefully through the following list and choose the closest description of your business: |
JANITORIAL CLEANING
|
| Business Description (Please describe in detail the nature of the business) |
---
|
| Will your business be selling or serving alcohol? |
---
|
| Start of business date |
---
|
| Locations where the business or applicant has operated during the last 5 years: |
---
|
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) only) |
---
|
| Phone Number |
---
|
| *Check the boxes next to the document you are presenting to the Town, indicating lawful presence |
---
|
| Attach a copy of said document |
---
|
Applicant Information (Must be completed by the person filling out this application)
| Name (First and Last) |
---
|
| Home Address (No PO Boxes) |
---
|
| Phone number |
---
|
| Driver's License Number |
---
|
| Driver's License Expiration Date |
---
|
| Date of Birth |
---
|
| Social Security Number (Last four (4) digits ONLY) |
---
|
| Email Address |
[email protected]
|
Partnership
| 1. Partner/Owner (First and Last Name) |
---
|
| Home Street Address (cannot be a PO Box) |
---
|
| Telephone Number |
---
|
| Social Security Number (Last four (4) digits only) |
---
|
Federal Tax ID or Social Security Number
| Please enter your Federal Tax ID Number |
---
|
Professional Licenses
| Professional License or Permit Number & Description |
---
|
Application Affidavit
