File and pay by due date to avoid a penalty.
Part 6
I hereby swear or affirm that all the information listed above is true and correct to the best of my knowledge.
Signature Printed Name Title Date
Part 6
I hereby swear or affirm that all the information listed above is true and correct to the best of my knowledge.
Signature Printed Name Title Date
Part 4 Alcoholic Beverages (If your business does not sell alcoholic beverages, check here. q)
Are mixed beverages sold on the premises? (Check One) q Yes q No
What is the maximum seating capacity? (Check One) q 1 – 100 q 101 – 150 q 151+
Do you sell Beer and/or Wine? (Check All That Apply)
Beer: On Premises Only: q Yes q No Off Premises Only: q Yes q No Both: q Yes q No
Wine: On Premises Only: q Yes q No Off Premises Only: q Yes q No Both: q Yes q No
Part 4 Alcoholic Beverages (If your business does not sell alcoholic beverages, check here. q)
Are mixed beverages sold on the premises? (Check One) q Yes q No
What is the maximum seating capacity? (Check One) q 1 – 100 q 101 – 150 q 151+
Do you sell Beer and/or Wine? (Check All That Apply)
Beer: On Premises Only: q Yes q No Off Premises Only: q Yes q No Both: q Yes q No
Wine: On Premises Only: q Yes q No Off Premises Only: q Yes q No Both: q Yes q No
Part 2 Contractors
(Copy of State License and VWC Certificate of Workers’ Compensation
Insurance Acknowledgment must be included. Check here if enclosed.
q)
State Contractor’s License Type: (Check One) q Class A q Class B q Class C Classification: _____________________
Enter State Contractor’s License Number: _______________________________________ Expiration Date: ___________________
Part 2 Contractors
(Copy of State License and VWC Certificate of Workers’ Compensation
Insurance Acknowledgment must be included. Check here if enclosed.
q)
State Contractor’s License Type: (Check One) q Class A q Class B q Class C Classification: _____________________
Enter State Contractor’s License Number: _______________________________________ Expiration Date: ___________________
Part 1 Business Information
* Confidential — for Commissioner Office Use Only
Trade Name
Owner Name Telephone Number *
Mailing Address
City State Zip
Business Address
Email Address *
State ID Number Federal ID No./Social Security No.
Type of Business:
q Individual q Partnership q Corporation q LLC
Date Business Began in Winchester
Date Closed (if applicable)
Part 1 Business Information
* Confidential — for Commissioner Office Use Only
Trade Name
Owner Name Telephone Number *
Mailing Address
City State Zip
Business Address
Email Address *
State ID Number Federal ID No./Social Security No.
Type of Business:
q Individual q Partnership q Corporation q LLC
Date Business Began in Winchester
Date Closed (if applicable)
Part 5 Local Excise Taxes
Are any sales subject to the following?
(Check All Applicable)
q Meals Tax q Lodging Tax q Admissions Tax q Short-Term Rental Tax
Part 5 Local Excise Taxes
Are any sales subject to the following?
(Check All Applicable)
q Meals Tax q Lodging Tax q Admissions Tax q Short-Term Rental Tax
2021 City of Winchester
Business License Application
(See Reverse for Instructions)
CONTROL NUMBER
Due Date March 1, 2021
Part 3 Financial Information (Gross Receipts)
Business Type
If Including
Payment, Enter
Amount Enclosed
FOR USE BY
COMM OF REVENUE
Contractor
Retail Sales
Repair, Personal and
Business Services
Financial, Real Estate and
Professional Services
Wholesale Merchants *
(*Report Gross Purchases)
Other Types of Businesses
Enter Prior Year
Gross Receipts
(2020)
If Business Began After
January 1, 2020,
Enter Estimated Gross
Receipts (2021)
21 S. Kent St., Ste. 100, Winchester VA 22601
Phone: 540-667-1815 • Fax: 540-667-8937
www.winchesterva.gov
