License # __________________
City of Charleston
South Carolina
Revenue Collections Division
(Office use only) NAICS CODE__________ (Office use only) CLASS____________
Joshua D. Richards
John J. Tecklenburg
Please print legibly all available information
Business Name__________________________________ DBA ________________________________
Retail License No.________________________ Federal ID No. ________________________
Contractor License No.______________________ DL No. _____________________________
Entity Type (check one): Sole Proprietorship Partnership Corporation LLC
Physical Address ________________________________________________ Zip Code_______________
Business Phone Number _____ _____ ________ Cell ______ _______________Fax _____ _____ ________
Mailing Address _______________________________________________ Zip Code________________
Email Address __________________________________Web Address _____________________________
Business Activity Description_________________________________________
Will you sell prepared meals, food, or beverages? yes or no If yes, business is subject to hospitality tax
Is business location within City of Charleston? yes or no If yes: home based or storefront/office
Owner Name_____________________________ __________________ ____________
(last name) (first name) (middle initial)
Owner Title____________________________ Owner Email__________________________________
Owner Address_______________________________________________ Zip Code________________
Owner Phone Number/Cell Number _______ _________ __________
Contact Person_______________________________________ Contact Email _______________________
Date Business Opened/Started in City Of Charleston__________________________
Will you rent accommodations? yes or no If yes, business is subject to state and local accommodations taxes
Landlord Name_______________________________________
Estimated Gross Receipts from Open Date through 12/31 _______________________________
I certify the above information is true and accurate. ________________________________ Date ____________
(signature of applicant)