Fillable APPLICATION FOR CREDIT ACCESS BUSINESS CERTIFICATE OF REGISTARTION (City of Longview)

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APPLICATION FOR CREDIT ACCESS BUSINESS CERTIFICATE OF REGISTARTION (City of Longview)

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BROWSE CITY OF LONGVIEW (TX) FORMS

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REC-16 (03/2016)
APPLICATION FOR
CREDIT ACCESS BUSINESS
CERTIFICATE OF REGISTARTION
LONGVIEW CITY ORDINANCE
CHAPTER 20 BUSINESS REGULATIONS
$20 FEE FOR NEW LICENSE OR LICENSE RENEWAL
NEW LICENSE LICENSE RENEWAL
FOR LICENSE RENEWALS ONLY PLEASE INDICATE CURRENT LICENSE NUMBER AND EXPIRATION DATE
L
ICENSE NUMBER: ____________________ EXPIRATION DATE OF LICENSE: ___________________
N
AME OF APPLICANT: __________________________________________________________
S
TREET ADDRESS: ______________________________________________________________
ADDRESS CITY STATE ZIP
MAILING ADDRESS:
ADDRESS CITY STATE ZIP
PHONE NUMBER: FACSIMILE NUMBER:
NAME OF BUSINESS UNDER WHICH APPLICANT WILL OPERATE:
___________________________________________________________________________
ADDR
ESS AT WHICH APPLICANT WILL OPERATE AND MAINTAIN RECORDS:
____________________________________________________________________________
ADDRESS CITY STATE ZIP
B
USINESS PHONE: ________________________ FACSIMILE NUMBER: ___________________
M
AILING ADDRESS: ____________________________________________________________
H
AVE YOU EVER ENGAGED IN BUSINESS UNDER AN ASSUMED NAME?
YES NO
I
F YES, LIST NAME(S) ___________________________________________________________
____________________________________________________________________________
DO NOT WRITE IN THIS SPACE
LICENSE NO. __________________
APPROVED DATE
ISSUED DATE
DENIED DATE
REC-16 (03/2016)
OTHER OWNERS OF CREDIT ACCESS BUSINESSES
1. NAME: _____________________________________________________________________
S
TREET ADDRESS: ____________________________________________________________
M
AILING ADDRESS: __________________________________________________________
T
ELEPHONE NUMBER: ________________________________________________________
I
NTEREST IN CREDITED BUSINESS: _______________________________________________
___________________________________________________________________________
2. N
AME: _____________________________________________________________________
S
TREET ADDRESS: ____________________________________________________________
M
AILING ADDRESS: __________________________________________________________
T
ELEPHONE NUMBER: ________________________________________________________
I
NTEREST IN CREDITED BUSINESS: _______________________________________________
___________________________________________________________________________
3. N
AME: _____________________________________________________________________
S
TREET ADDRESS: ____________________________________________________________
M
AILING ADDRESS: __________________________________________________________
T
ELEPHONE NUMBER: ________________________________________________________
I
NTEREST IN CREDITED BUSINESS: _______________________________________________
___________________________________________________________________________
4. N
AME: _____________________________________________________________________
S
TREET ADDRESS: ____________________________________________________________
M
AILING ADDRESS: __________________________________________________________
T
ELEPHONE NUMBER: ________________________________________________________
I
NTEREST IN CREDITED BUSINESS: _______________________________________________
___________________________________________________________________________
5. N
AME: _____________________________________________________________________
S
TREET ADDRESS: ____________________________________________________________
M
AILING ADDRESS: __________________________________________________________
T
ELEPHONE NUMBER: ________________________________________________________
I
NTEREST IN CREDITED BUSINESS: _______________________________________________
___________________________________________________________________________
REC-16 (03/2016)
I, THE UNDERSIGNED, UNDERSTAND THAT A BACKGROUND INVESTIGATION WILL BE
CONDUCTED TO ESTABLISH MY ELIGIBILITY FOR THIS LICENSE.
I, THE UNDERSIGNED, UPON OATH STATE THAT ALL ANSWERS ON THIS APPLICATION
ARE TRUE AND COMPLETE, AND I AM AWARE THAT ANY FALSE OR MATERIALLY
INCOMPLETE ANSWERS ARE GROUNDS FOR DENIAL OF THIS LICENSE OR
REVOCATION OF LICENSE.
____________________________________
APPLICANT SIGNATURE
____________________________________
DATE
STATE OF TEXAS
COUNTY OF GREGG
SUBSCRIBED AND SWORN TO BEFORE ME, THE UNDERSIGNED NOTARY PUBLIC, ON THIS ____
DAY OF ____________, 20___.
_____________________________________
NOTARY PUBLIC
MY COMMISSION EXPIRES ________________
ITEMS REQUIRED WITH APPLICATION
COPY OF PHOTO ID
VALID CERTIFICATE OF OCCUPANCY
VALID CREDIT ACCESS BUSINESS STATE LICENSE
NON-REFUNDABLE APPLICATION FEE
ONCE APPLICATION IS COMPLETE, PLEASE INCLUDE A COLOR COPY OF THE APPLICANTS
DRIVERS LICENSE ALONG WITH ANY OTHER REQUIRED DOCUMENTS AND MAIL TO THE
ADDRESS LISTED BELOW ALONG WITH THE APPLICATION FEE. ONCE PROCESSED YOUR
PERMIT WILL BE MAILED TO THE ADDRESS LISTED ON THIS APPLICATION.
LONGVIEW POLICE DEPARTMENT
ATTN: RECORDS DEPT
P.O. BOX 1952
LONGVIEW, TEXAS 75606
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APPLICATION FOR CREDIT ACCESS BUSINESS CERTIFICATE OF REGISTARTION (City of Longview)

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Completed 3 August 2020

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