MAIL APPLICATION AND FEE TO:                                                                               CONTACT INFO:
  SALES TAX & LICENSING DIVISION                                                                             EMAIL      salestax@louisvilleco.gov
  749 MAIN STREET                                                                                            PHONE      (303) 335-4524 or 4570
  LOUISVILLE, CO 80027                                                                                       FAX        (303) 335-4527
  www.louisvilleco.gov

                                      20____ SALES/USE TAX LICENSE APPLICATION
                                                          License Fee $25.00

1 Trade (DBA) Name of Business

  Taxpayer Name
  Owner(s), Partner(s), or Corporation
  Business Location Address
  -Street, City, State, Zip-
  Mailing Address
  -Street, City, State, Zip-
  Local Business Phone                Local Business Fax                         Business Email
  (       )                   ext.    (       )   
  Licensing Office Phone              Licensing Office Fax                       Licensing Office Email
  (       )                   ext.    (       )   
  Tax Office Phone                    Tax Office Fax                             Tax Office Email
  (       )                   ext.    (       )   
  Owner Name, Phone, & Address
  (Or attach officer listing)         (       )              ext.

2 Type of Ownership                    Sole Proprietor     Corporation          Partnership            S. Corp
                                       LLC                 Non-Profit           Other (Please Specify)
  Business Description
  (Required)
  Primary Business Type                Apparel/Accy's      Bldg Materials (Retail or Time & Materials)  Construction (Lump Sum)
                                       Comm/Util/Trans     Consulting/Software  Eating/Drinking        Finance/Leasing
                                       Food Stores         Furniture/Appliance  Gen Merchandise        Manufacturing
                                       Pers/Bus Services   Wholesale            Other (Please Specify)
  Federal Tax I.D                       ___ ___ - ___ ___ ___ ___ ___ ___ ___
  Colorado State Sales Tax #            ___ ___ - ___ ___ ___ ___ ___ ___
  Sales/Use Tax Filing Period          Monthly             Quarterly            Semi-Annual            Annual
                                      $100 or more/mo      $99 or less/mo        $50 or less/yr          $25 or less/yr
  Do you want us to mail you           Yes                                      Blank and self-calculating City tax returns are available on-
  City tax returns?                    No                                       line at www.louisvilleco.gov
  Date Business Started/Will Start,
  or Date of First Sale in Louisville   ___ ___ / ___ ___ / ___ ___ 
  Is Your Business Physically          Yes                If "Yes" you must sign this page and complete Page 2.
  Located in the City of Louisville    No                 If "No" please sign and date application and submit with fee.

3 I declare under penalty of perjury that the statements made in this application are true and complete to the best of my knowledge.
  Applicant or 
  Authorized Agent Signature                                                                             Date
  Applicant Name (PRINT)                                                                                               New Application
  Applicant Title                                                                                                      Renewal

  SALES TAX & LICENSING DIVISION                                                                                                   EMAIL       salestax@louisvilleco.gov
  749 MAIN STREET                                                                                                                  PHONE       (303) 335-4524 or 4570
  LOUISVILLE, CO 80027                                                                                                             FAX         (303) 335-4527
  www.louisvilleco.gov

                                                    20____ APPLICATION - PAGE 2
                      (This form is ONLY for businesses and home occupations with a physical location in Louisville)

4 Trade (DBA) Name of Business

  Louisville Location Address
  -Street, City, State, Zip-
  CEO
  Name, Address, Phone, Email           (       )     ext.                                                                                     @
  Manager/Administration
  Name, Address, Phone, Email           (       )     ext.                                                                                     @
  Company Web Site                      Years in Current Location                                             Previous Address

  Number of Employees in Louisville     Full-Time     Part-Time                                                        Seasonal                Ind Consultants

5 Do you Own or Lease your Building?     Own        Lease (if leased, please complete landlord information)
  Landlord Name, Phone# & Address 
  for this Louisville Location:         (       )     ext.
  Type of Business/Sales
  (Detailed Description of Business
  Operations)
  Total Square Footage of Location:                                                                           Will there be changes or                      Yes
                                                                                                              modifications to this site?                   No
  Do you report hazardous materials      Yes       Location of MSD Sheets and/or
  under EPCRA or 112R?                   No        on-site Hazmat Inventory List
  Normal Business Hours                             Who should the City contact
                                                    for a site visit?

6 Home Occupation?                       Yes        No
  If Yes, total finished square footage                                                                       Total finished square 
  of this home in Louisville:                                                                                 footage of work area:
  By signing this application, you agree to the conduct your home-based business subject to the terms and limitations described in 
  Section 17-16-040 of the Louisville Municipal Code.  It is the applicants responsibility to review the Code.

7 Date this business                                                                                          Did the sale include any                      Yes
  was purchased:                                                                                              assets, equip, or similar?                    No
  Former Name of Business
  (At this location)
  Emergency Contact & Phone#                                                                                                       (          )
  Burglar Alarm (Name & Phone)                                                                                                     (          )
  Fire Alarm (Name & Phone)                                                                                                        (          )
                                                    FOR CITY USE ONLY 
8                                                     Signature/Comments
  Planning                 Yes          No