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Revised 02/2020
VEHICLE INFORMATION: PLEASE LIST INFORMATION ON OWNER AND EMPLOYEE(S) AS WELL AS VEHICLES THAT MAY BE
ON THE BUSINESS PREMISE AT ODD HOURS.
DRIVER VEHICLE (MAKE, MODEL, AND YEAR) LICENSE PLATE #
Hazardous Material on Premise?
N/ANOYES
If YES, list items (attach separate sheet if needed):
NOYES
Does Building Have Exterior Electrical Shut Off? If YES, on which side?
North South East West
Is the building equipped with automatic Fire Sprinklers? YES NO
Are street address numbers installed on building? YES NO
If YES, are they visible from the street?
NOYES
Will this business require:
Date Business Opens Under New Owner:
No. of Employees:
Business Hours:
Type of Business (select one or provide "other" description) General
Partnership, Limited Partnership, Corporation, Association, Individual:
WARNING: A person commits an offense, with intent to deceive and with knowledge of the statement's meaning, he/she makes a
false statement under oath or swears to the truth of a false statement previously made and the statement is required or authorized by
law to be made under oath.
Before me, the undersigned authority, this day personally appeared ____________________________________, known to me to
be the person whose name if subscribed to the foregoing Business Registration Form, who being by me first duly sworn, upon
oath says that he/she has read the said form in its entirety, together with any supporting documentations, that he/she has
personal knowledge of all the information set forth therein, and that such information is true and correct.
Applicant's Signature Notary Public, State of Texas
Received By:
Receipt #:
STAFF ONLY -- DO NOT FILL OUT
Date Submitted:
BUSINESS REGISTRATION FORM
Commercial Dumpster Commercial Hand Pick-Up
SWORN AND SUBSCRIBED BEFORE ME THIS ____________ ,
DAY OF __________, 20____.
