Business License Application City of Wyoming
City Clerk’s Office
1155 28
th
Street SW
Wyoming, MI 49509-0905
616-530-7296 fax 616-530-7200
Owner Name:
DATE BUSINESS OPENED:
□ Sole proprietor
□ Partnership
□ Corporation
Owner Mailing Address:
Phone: ______________________
(not business phone)
Fax: _____________________
Email: _____________________
FEIN: State Tax ID# State License #
Business Name:
Business Address:
Business
Phone: ___________________
Business
Fax: ___________________
Description of Business:
Business Classification:
From attached list of Business Activity Codes,
enter code for activity from which business
derives its largest percentage of total receipts.
Additional Owner Info:
Home Phone:___________________
Business Phone: ________________
Cell Phone: ____________________
Name:_______________________________________________________
Address: ____________________________________________________
City, State, Zip: _______________________________________________
Emergency Contact #1:
Home Phone:___________________
Business Phone: ________________
Cell Phone: ____________________
Name:_______________________________________________________
Address: ____________________________________________________
City, State, Zip: _______________________________________________
Emergency Contact #2:
Home Phone:___________________
Business Phone: ________________
Cell Phone: ____________________
Name:_______________________________________________________
Address: ____________________________________________________
City, State, Zip: _______________________________________________
I declare, under penalty of perjury, that the information contained in this application is true and correct.
________________________________ ______________ ______________
Signature Title Date
FOR OFFICE USE ONLY
BUSINESS TYPE:
□ Entered
DATE APP RECEIVED: DATE FEE RECEIVED: FEE RECEIVED: $
INITIALS: INITIALS: LIC #
