Standardized Business License Application
City or County:
Business Information
Corporate name:
Name shown to public:
Open date:
Organization type: Sole proprietor LLC LLP LP Corporation
Articles of Organization or Incorporation may be required.
Business activity/type:
NAICS/SIC/Other code:
Federal ID/SSN #:
State retail sales #:
Mailing address:
Physical
address:
Inside jurisdiction, Tax parcel #:_________________ Outside jurisdiction
Contact name, title:
Contact phone: Ext.
Alternate phone:
Fax:
Email:
Owner or Principal(s) Information
Owner or Principal(s)
name(s), title(s):
SSN #:
SSN #:
Driver’s license #:
Expiration date:
Mailing address:
Work phone: Ext.
Cell phone:
Fax:
Email:
Job/Project Information
Project start date:
Estimated end date:
Project location:
Tax parcel #:
Project type: New construction Renovation Other ___________________________________________________
General contractor name:
State contractor license #: State: Expiration date:
Copy may be required
Master/specialty license #:
Job contact name:
Phone:
Total gross revenues of contract amount: $
Gross revenues, inside jurisdiction: $
Gross revenues, outside jurisdiction: $
Value of authorized deductions: $
Deduction type(s):
Contact your city or county business licensing office with questions regarding this form.
Application produced by the South Carolina Business Licensing Officials Association.
The SC Business Licensing Officials Association is an affiliate of the Municipal Association of SC.
TOWN OF JACKSON
Other Information
Yes No
Buying an existing construction business?
If yes, purchased business’ name:
Business leasing space to another business?
Yes No
Mail business license renewals to mailing address listed in the business information section on the previous page?
If not, corporate address:
Yes No
Change of use to building?
Yes No
Erecting a new sign?
Yes No
Home occupation?
Yes No
Independent contractors (Form 1099)?
If yes, names:
Yes No
Leasing property?
If yes, landlord name and address:
Yes No
Restrictive covenants? If yes, provide copy.
Yes No
Do you sell food or beverages that are prepared and/or consumed on your premises?
Applicant Certification (Contact the municipality in which you are doing business to determine if a notarized signature is required.)
1. I hereby certify that all information provided is true and correct to the best of my knowledge and that the gross revenue is
accurately reported or estimated for a new business without any unauthorized deduction.
2. I certify that assessments, delinquencies and personal property taxes due to the jurisdiction are fully paid
.
3. I understand that providing false or fraudulent information may result in penalties, business license revocation and/or
prosecution to the fullest extent possible
.
4. I
am aware of and understand the jurisdiction’s requirements and codes, and the issuance of a business license is contingen
t
u
pon strict and consistent compliance with all of the jurisdiction’s requirements
.
5. I
understand that failure to comply with these requirements may result in business license revocation as well as othe
r
comp
liance or legal effo
rts.
6. I
also understand and authorize the jurisdiction and its agents to utilize all information on this application to ensure that
all
other federal, state and local laws are complied with.
Applicant printed name: Signature:
Title: Date:
For Office Use Only
Approved by all necessary departments? Yes No
Comments
Approved? Yes No
Date:
Business license #:
Rate class:
Rate Base rate: $
Every $1,000 after: $
Amount due Fee: $
Penalties: $
Total: $
Decal required? Yes No
Cost/each: $
Total: $
Receipt Amount paid: $
Date paid:
Number of decals:
Staff name:
Signature:
Date:
Contact your city or county business licensing office with questions regarding this form.
Application produced by the South Carolina Business Licensing Officials Association.
The SC Business Licensing Officials Association is an affiliate of the Municipal Association of SC.
Yes No
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome