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BUSINESS LICENSE APPLICATION
CALENDAR YEAR ________________
NAME: ______________________________________________________
BUSINESS NAME: ______________________________________________________
BUSINESS LOCATION: ______________________________________________________
MAILING ADDRESS: ______________________________________________________
______________________________________________________
PHONE NUMBER: _______________ ALTERNATE NUMBER: _______________
E-MAIL ADDRESS: ______________________________________________________
TAX ID OR SS #: ______________________________________________________
TYPE OF BUSINESS: ______________________________________________________
GROSS RECEIPT AMOUNT: ________________________________________________
_____________________ PER $100.00 OF GROSS RECEIPTS TOTAL FOR ENTIRE YEAR
(based upon business category – see www.townofwoodstockva.com/316/business-licenses for more
details on fees)
SIGNATURE: ______________________________________________________
DATE: ______________________________________________________
(for Office Use only)
DATE RECEIVED: _________________ TOTAL PAID: ___________________________________
LICENSE FEE DUE (EXCLUDING PENALTY): __________________________________________________
PENALTY AMOUNT (IF APPLICABLE): __________________________________________________
LICENSE NUMBER: __________________________________________________
