MONTGOMERY COUNTY BUSINESS LICENSE APPLICATION 
                                                               101 S. Lawrence Street, Montgomery, AL 36104 
                                                                                                        (334) 832-1248 
                                                                                                                   
1. Business Name:                                       ____________________________________________________________________________________________________________ 
 
          Mailing Address:                              ____________________________________________________________________________________________________________ 
          City:                                         ____________________________________________ State: ________________________________ Zip:____________________ 
2.  BusinessPhysicalPhone:Address:                      _____________________________________________________________________________________________________________________________________________________ 
3.  Is thisIsabusinesshome basedinsidebusiness?           the city limits? (Please check one)                                Yes                                                No 
4.  Briefly describe business:  _______________________________________________________________________________________________________________ 
5.  Date Business Opened in Montgomery(PleaseCounty: check___________________________one)                                    Yes                               No
6.  Business Type:  
 
                              (Please check one) 
                                                               Sole Proprietor                             Social Security No. _______________________________ 
7.  Business or Owner’s Email Address: Partnership________________________________________Federal I.D. No.       _______________________________ 
                                                               Corporation 
8.  Owner’s Name                                               Title                      Address                                                                                   Telephone # 
       ____________________________________                    _______________  ____________________________________________________________                                        __________________________ 
       ____________________________________                    _______________  ____________________________________________________________                                        __________________________ 
       ____________________________________                    _______________  ____________________________________________________________                                        __________________________ 
       ____________________________________                    _______________  ____________________________________________________________                                        __________________________ 
9.  SALES – Retail or Wholesale 
  
       Do(checkyou haveall itemsa licenseyoutosell)sell in another county in Alabama? (Please check one)                                                                        Yes                                      No          
       Fixed Location (Permanent) or Transient ____________________
                                                                            Bicycles                                               Tobacco                                          Electronics 
                                                                            Computers                                              Magazines                                        Playing Cards 
                                                                            Cell Phones                                            Appliances                                        
 10.    CONTRACTOR SERVICES (Paint, construction,Auto Accessoriesroofing, etc.)                                                    Soft Drinks 
                                                                                                                                                                                       
       (Note:  If you have answered “Yes”, please contact us at 334-832-1248 before proceeding.) 
       ProvideDo you havean estimatea valid Sectionof gross84 (contractor’sreceipts in thelicense)StateinofanotherAlabamacountyfor fiscalin Alabama?tax year:  (Please$_________________________check one)         Yes                    No 
                                                                                                                                                                                  (SUBJECT TO AUDIT)   
 
11. Additional Permits Required for:(Fiscal period – October 1 – September 30)                                                                                     
 
       Food Service, Auto Dealer, Auctioneer or Second County Transient 
                                                                                                                  Bond #:                                                       ___________________________ 
                                                                                                                  Regulatory License#:                                          ___________________________ 
                                                                                                                  Health Permit#:                                               ___________________________ 
 12.    I declare under penalty of                             perjury that the above informationFirst County:is true and correct.___________________________ 
  
       ________________________________________________________________                                                                     ___________________________
                  Signature of owner or authorized agent                                                                                                Date 
                                                                                                                                                                                        
                                                                                                                     OFFICE USE ONLY                                                  ________________ 
                                                                                                                                                                                           Clerk 
       Section                                                Fee                                      Section                                                                   Fee                               
       ___________________________________     _____________                                           _________________________________   ______________            __________________ 
       ___________________________________     _____________                                           _________________________________   ______________                  License# 
       ___________________________________     _____________                                           _________________________________   ______________                   
                                                                                                                                                                                   __________________ 
                                                                                                                                                                                                                   ID#