Date:
PERSONAL INFORMATION
NAME
MAILING ADDRESS
PHONE
BUSINESS INFORMATION
NAME OF BUSINESS
LEGAL BUSINESS NAME (if different)
BUSINESS TYPE:
SOLE PROPRIETORSHIP LLC CORPORATION S CORP LLP OTHER
PHYSICAL ADDRESS
MAILING ADDRESS
PHONE
ON-SITE MANAGER/EMERGENCY CONTACT
PHONE
ALTERNATE EMERGENCY CONTACT
PHONE
ARIZONA TRANSACTION PRIVILEGE TAX NUMBER (TPT)
NORTH AMERICAN INDUSTRY CLASSIFICATION SYSTEM CODE (NAICS)
EMPLOYER IDENTIFICATION NUMBER (EIN)
TYPE OF BUSINESS OR GOODS / WARES / MERCHANDISE / SERVICES TO BE SOLD:
DO YOU STORE, HANDLE, OR DISPENSE HAZARDOUS MATERIALS?
IF YES, PLEASE DESCRIBE:
SIGNATURE
Office use only: Data entry date:
Received by:
Paid: Check# CC Cash
Zoning:
Approved
Denied
Additional Action:
Complete where applicable and return to the City of Page, City Clerk's Office, P.O. Box 1180, 697 Vista
Avenue, Page, Arizona 86040, with registration fee in the amount of $25.00.
CITY OF PAGE
BUSINESS REGISTRATION APPLICATION
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signature
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