CITY OF HELENA 
 BUSINESS REVENUE OFFICE 
 CITY SALES, USE AND RENTAL/LEASE TAX APPLICATION FORM 
  
 PLEASE PRINT THE INFORMATION REQUESTED BELOW 
 AND MAIL OR FAX TO THE OFFICE BELOW 
  
 BUSINESS PHYSICAL LOCATION INFORMATION 
 
BUSINESS NAME: _______________________________________________________ 
BUSINESS ADDRESS: ____________________________________________________ 
BUSINESS CITY/STATE___________________________ZIP CODE: _______-______ 
BUSINESS TELEPHONE NO: _______________________FAX:__________________ 
 BUSINESS TYPE (LIST PRIMARY PRODUCT, SERVICES) 
___________________________________________________________________________
___________________________________________________________________________ 
BUSINESS STATE SALES TAX NO._____________ SHELBY CO. NO.____________ 
FEIN: __________________________ HELENA BUSINESS LIC.NO.______________ 
EMPLOYEE OR ACCOUNTANT PREPARING TAX RETURNS: ________________________________ 
 
 BUSINESS MAILING ADDRESS INFORMATION (IF DIFFERENT) 
 
ATTENTION: ___________________________________________________________ 
BUSINESS MAIL ADDRESS: _____________________________________________ 
                                                     _____________________________________________ 
BUSINESS CITY, STATE: __________________________ZIP CODE:_______-_____ 
 
 OWNER(S) MAILING ADDRESS INFORMATION (IF DIFFERENT) 
 
OWNER(S) NAME: _______________________________________________________ 
ATTENTION: ____________________________________________________________ 
OWNER(S) TELEPHONE NO: ______________________FAX NO: ________________ 
OWNER(S) MAILING ADDRESS: __________________________________________ 
                                                          __________________________________________ 
CITY, STATE_____________________________________ZIP CODE: _______-______ 
 
CHECK APPLICABLE CITY TAX TYPE(S) :  (  ) SALES    (  ) CONSUMERS USE   (  ) SELLERS USE   (  ) RENTAL/LEASE 
FILING STATUS:               (  ) MONTHLY   (  ) QUARTERLY   (  ) ANNUAL    (  ) OCCASIONAL 
 
NAME OF APPLICANT: __________________________________________________ 
 PLEASE PRINT 
 
SIGNATURE OF APPLICANT: _____________________________DATE:____________ 
 
 MAIL APPLICATION TO: 
 CITY OF HELENA LICENSE OFFICE 
 PO BOX  613 
 HELENA AL  35080-0613 
 PHONE  (205) 663-2161   FAX (205) 663-9276 
 
YOU ARE RESPONSIBLE FOR CONTACTING THE STATE SALES TAX OFFICE FOR YOUR STATE SALES/USE TAX ACCOUNT AND 
YOUR COUNTY TAX OFFICE FOR YOUR COUNTY SALES/USE TAX ACCOUNT.