CITY OF FORT PAYNE, ALABAMA BUSINESS LICENSE APPLICATION 
           The City Does Not Impose the Business License Tax in its Police Jurisdiction 
                                                                                                         
        Complete and Mail-Fax-Email To:                               (CONFIDENTIAL)                                Applicant Complete This Box 
                                                                                                
         CITY OF FORT PAYNE                                                                     FEIN or SSN 
        100 ALABAMA AVENUE N.W. 
        FORT PAYNE, ALABAMA  35967                                                              ST of ALA TAX # 
                                                                                                
                                                                                                               FORM OF OWNERSHIP (Check One) 
         aparker@fortpayne.org                                                                                                                 
                                                                                                 Sole Prop. _____    Partnership ______ 
 Ph (256) 996-5102         Fax (256) 845-2987                                                    Corp.  _____                               Prof Assoc.  ______ 
                                                                                                 LLC  ______                                Other ___________ 
                                                                           
                                                                Please Print or Type 
                      SEE REVERSE SIDE FOR INSTRUCTIONS AND FURTHER INFORMATION 
                                                                            
Application Type :  New ____    Owner Change ____    Name Change _____    Location Change _____ 
 
Legal Business Name :  __________________________________________________________________________________________ 
Trade Name: (If different from above) _________________________________________________________________________________ 

Business Activities:(Brief description- Retail clothing sales, wholesale food sales, rental of industrial equip., computer consulting, etc) 

________________________________________________________________________________________________________________ 

Physical Address:           ___________________________________________________________________________________________ 
                                 (Street)                                   (City)                                                    (State)              (Zip) 
Mailing Address:            ___________________________________________________________________________________________ 
                                 (Street)                                   (City)                                                    (State)              (Zip) 
Telephone:                  ___________________________________________________________________________________________ 
                                 (Business)                                 (Fax)                                                     (Home Phone) 
 
Name & Phone # for Contact Person ________________________________________________(______)__________________________ 
Email address for contact:            ___________________________________________________ 
 
List Following for Owner(s), Partners, or Officers (Attach separate sheet if necessary) 
Name                        Residence Address                               SSN (if not publicly traded co.)                                       Title 

Date Business Activity Initiated or Proposed in Fort Payne:___________________  # of Employees in Fort Payne _________________ 
 
This application has been examined by me and is, to the best of my knowledge, a true and complete representation of the above named entity, and person(s) 
listed. 
 
Date ____________________       Signature ___________________________________________________Title _________________________________ 
 
                                              THIS AREA FOR MUNICIPAL USE ONLY  
 
ACCOUNT ID #                                   NAICS CODE:                                                           REVIEWED BY: 
 
PHYSICAL LOCATION:              CITY            POLICE JURISDICTION                                                 OUTSIDE CORP LIMITS & PJ 
 
ZONING CLASSIFICATION: ______________  BUILDING APPROVAL:     YES     NO                                     N/A                   FIRE CODE                    
 
Business Type:         Retail             Wholesale           Building Contractor           Service               Professional        
                          Manufacturer                               Rental                                 Other_________________________ 
APPROVAL BY:                Zoning:            Building:                             Fire: 

     PLEASE READ THE FOLLOWING INFORMATION CONCERNING THE COMPLETION OF THIS FORM 
                                                        
 PLEASE COMPLETE ALL AREAS OF THE FORM EXCEPT FOR THE SHADED AREA AT THE BOTTOM OF 
  PAGE 1. 
 
 FORM SHOULD BE TYPED OR PRINTED LEGIBLY 
 
 FORM SHOULD BE DATED AND SIGNED BY AN OWNER, PARTNER, OR OFFICER OF THE BUSINESS 
 
 FORM WILL INITIATE THE PROCESS FOR REGISTERING YOUR BUSINESS WITH THE MUNICIPALITY 
 
 IF YOUR BUSINESS WILL HAVE A PHYSICAL LOCATION WITHIN THE MUNICIPALITY PLEASE 
  USE THAT ADDRESS ON THE FRONT OF THIS FORM. (Complete separate forms for each physical 
  location in the city) 
 
 AFTER COMPLETING THIS FORM IT CAN BE MAILED, SENT BY FAX OR WHERE POSSIBLE,                                               , 
  SENT BY ELECTRONIC    MAIL TO THE MUNICIPALITY        . 
 
 UPON  RECEIPT  OF  THE  COMPLETED  FORM,  THE  MUNICIPALITY  WILL  PROVIDE  ANY 
  ADDITIONAL FORMS AND INFORMATION REGARDING OTHER SPECIFIC REQUIREMENTS TO 
  YOU IN ORDER TO COMPLETE THE LICENSING PROCESS. 
 
ALL  LICENSE  RENEWALS  ARE  DUE  JANUARY  1   AND  DELINQUENT st AFTER  JANUARY  31 ,  WITH  THE st
FOLLOWING EXCEPTIONS: 
                                                        
     INSURANCE COMPANY LICENSE:    DUE JANUARY 1 , DELINQUENTstAFTER MARCH 1                        st
 
This  form  is  intended  as  a  simplified,  standard  mechanism  for  businesses  to  initiate  contact  with  a  municipality 
concerning their activities within that city.  A business license will be required prior to engaging in business.  If a business 
intends to maintain a physical location within the city, there are normally zoning and building code approvals required 
prior to the issuance of a license. 
 
In certain instances, a business may simply be required to register with the city to create a mechanism for the reporting 
and payment of any tax liabilities.  If that is the case, you will be provided the materials for that registration process. 
 
The completion and submission of this form does not guarantee the approval or subsequent issuance of a license to do 
business.  Any prerequisites for a particular type and location of the business must be satisfied prior to licensing. 
 
SHOULD THERE BE ANY QUESTIONS CONCERNING THE COMPLETION OF THIS FORM OR THE LICENSING 
AND/OR REGISTRATION PROCESS, PLEASE CALL THE NUMBER ON THE FRONT OF THIS FORM TO OBTAIN 
MORE DETAILED EXPLANATION.