For Office Use Only: 
                                                                                                     Date Received:  
                                                                                                     Amount Received: 
                                                                                                     Receipt #: 
                                                                                 Bus ID:              License #:  

                                          CITY OF LAPEER, MICHIGAN 
                                         Business Registration Application 

                               Type of Application New ($50.00)    Renewal ($10.00) 
                                                  NONREFUNDABLE 
                               PLEASE COMPLETE IN FULL -  RETURN WITH PAYMENT 

BUSINESS INFORMATION 
                                                          Website Address: 
Name of Business                                                                 Home Occupation       Yes        No 

DBA                                                                              Federal Id# 

Business Location                                                                Email address 

Business Phone                                            Business Fax   

Mailing Address (if different) 

Business Start Date                                       Property Tax ID # 

Business Start Date at this location (if different from above) 

Brief Description of Operation (types of goods/services)   

Number of Employees            Full Time                  Part Time                            Other 

Type of State License Possessed                                                  License No. 

Business Type    Corporation      Partnership     Sole Proprietorship               Other(Describe) 

Business Property   Own                   Lease                                  Zoned As     

If leased, property owner and address   

Is this a temporary business?     Yes      No                                    Expected Close Date 

Was this business located elsewhere in the city?          Yes             No    

If yes, where?  

Did this business operate under a different name in the previous year?          Yes              No If yes, what?   

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Leased equipment used in the business is owned by:   (If needed:  attach a separate list) 
              Name                          Address                                           Phone 
                                                                                                        
BUSINESS OWNER INFORMATION 
Name of Owner                                                                     Phone                

Owner’s Address                                                                                         

Name of Owner                                                                     Phone                

Owner’s Address                                                                                         

Name of Owner                                                                     Phone                

Owner’s Address                                                                                         

Name of person in charge of records                                                         Phone       
EMERGENCY INFORMATION 
Emergency Contact                                                                 Phone                 

Emergency Contact                                                                 Phone                 
BUILDING INFORMATION 
Alarm Company Name                                                                                      

Alarm Company Phone                                                                                     

Type of Alarms on Premises   Holdup         Break-in                              Fire      Silent    

Do you have a safe/vault on premises?       Yes                                   No          

Is the safe/vault visible from the outside? Yes                                   No         

Are there hazardous materials on the premises? Yes                                No        (If Yes, please attach a detailed list) 

Is there a sprinkler system?                Yes                                   No         

Domestic water usage only?                  Yes                                   No          
 
Projected amount of water usage and sewer discharge                                                                                                     
 
As the owner of the above said business making application for this registration or an authorized representative of said 
business and depose and say that I have read the foregoing application and know the contents thereof, and that the same 
is true to the best of my knowledge.  I further understand that this City of Lapeer Business Registration must be renewed 
as of January 1 stannually. 
 
Applicant Name                                                                    Owner       Manager   

Signature                                                                         Officer     Other     

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