BEAUFORT COUNTY BUSINESS SERVICE CENTER
P.O. DRAWER 1228 PHONE: 843-255-2270
BEAUFORT, SC 29901-1228 FAX: 843-255-9411
www.beaufortcountysc.gov
BL#_____________ YEAR___________
Legal Name of Business:______________________________________________________________________________________________________________________
DBA - Doing Business As:_____________________________________________________________________________________________________________________
Physical Address: ________________________________________________________________________City:__________________State: ___________Zip: __________
Mailing Address: _______________________________________________________________________City:___________________State:__________Zip:___________
.
Contact if different than owner: _________________________________________________________________________________________________________________
Business Phone #: __ __ __ - __ __ __ - __ __ __ __ Cell____ E-mail address:_______________________________________________________________
Website: ____________________________________Other Phone # __ __ __ - __ __ __ - __ __ __ __ Fax #__ __ __ - __ __ __ - __ __ __ __
Date Business Started in county: _____/______/____
Location: □ IN COUNTY □ OUT OF COUNTY □ OUT OF STATE
OWNERSHIP TYPE: □ SOLE PROPRIETOR □ CORPORATION □ PARTNERSHIP □ LIMITED LIABILITY COMPANY
Describe business activities in detail:_____________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________
Purchase Existing Business: YES_____ NO_____ Date of Purchase: ____/____/____ Previous Business Name:________________________________________________
FEIN # _______________________________ Social Security #_____________________________________SC Retail # ________________________________________
SC (LLR) LICENSE #: ____________________ EXP. DATE: ________________ TYPE OF LICENSE:_________________________________________________________
(i.e. Contractor, Electrical, Medical, Massage, etc.)
DRIVER LICENSE #_____________________________________________ STATE ISSUED___________________ DATE OF BIRTH_________________________________
Coin Operated Amusement Devices: YES___ NO___ Alcohol Beverages: YES____ NO_____ Prepared Foods: YES _____ NO _____ Paid entry or admission: YES ___ NO ____
II. IF BUSINESS IS OWNED BY A CORPORATION, ASSOC, OR OTHER ENTITY, PLEASE LIST NAME AND TITLE OF OFFICERS BELOW
OFFICER______________________________________________________TITLE________________________________________________________________________
OFFICER______________________________________________________TITLE________________________________________________________________________
Is this business an affiliate of a holding or parent company? Y___ N ___ If YES, name of parent company _____________________________________________________
_________________________________________________________________________________________________________________________________________
I certify under oath that the information given in this license application is true, that the gross income is accurately reported, or estimated for a new business, without any
unauthorized deductions, and that all assessments, fees, licenses, business property taxes, and any other charges due and payable to the County have been paid. I have
obtained County permits and am in compliance with all regulatory codes of Beaufort County. I understand the County ordinance provides for penalty and license revocation for
making false or fraudulent statements on this application.
Print Name:________________________________________________ Signature:____________________________________________________Date:_____/_______/____
ADMINISTRATIVE USE ONLY
DATED ACCEPTED: ______________ STAFF NAME: ________________________________
ZONING #____________________ CLASS/RATE_____________________________ VERIFIED: DRIVERS LICENSE/ID __________________
BUSINESS PERSONAL PROPERTY FORM COMPLETED ___________ ADDITIONAL ACCOUNTS SET-UP: LOCAL ATAX _________ HTAX___________ ADMISSION
___________