Finance Department, Sales Tax Office
                                                                                                                      155 South Seward St, Juneau, AK 99801
                                                                         BUSINESS REGISTRATION FORM                    Ph (907) 586-5265  Fax (907) 586-0365
                                                                                                                             Sales.Tax.Office@Juneau.org

                                                                                       CBJ USE ONLY
BP Property                                                                Sales Tax
Account No.                                                                Account No.                            Date          Initials

                                           Is this a:   New Business (    )          Change in Ownership (    ) *Complete Previous Owner section below
                                           Business                                                               AK Business
                                           Name                                                                   License No.
                                           Doing
Business                                   Business As
                   Identification                           (Enter 2-digit code from
                                           Line of Business                                       Federal ID No.
                                                            AK Business License)
                                                                                     Sales Tax Contact Information
                                           Mailing Address

                                           City                                                           State              Zip
                                           Contact Name                                                   Contact
                                           and Title                                                      Phone No.
                                                                           Business Personal Property Contact Information
                                           Complete this section only if Property Tax Contact Information differs from Sales Tax Contact Information
                                           Mailing Address
                   Contact Information
                                           City                                                           State              Zip
                                           Contact Name                                                   Contact
                                           and Title                                                      Phone No.
                                           Physical Location
                                           (Street Address)
                                                                                                                                                 CBJ Use Only
                                           City                                                   State           Zip                            M    Q    Y
                                           Business Phone No.                                     Business Email:
                                           General Description of
                                           Business Activity
                                           Start Date of Business Activity in Juneau
                   Other Business Info     Type of
                                                            Sole Proprietorship (    ) Partnership (    ) Corporation (    ) Other (    )______________
                                           organization:
                                           Will this business be selling  Liquor or  Marijuana?         Is it a Hotel/Motel or Bed & Breakfast?

                                           Previous Owner Name

                                           Previous Owner Address
                                      Owner
         *Previous
                                           City                                                           State              Zip

Under penalty of unsworn falsification, I attest that to the best of my knowledge that the information
provided on this application is true and correct.

Signature                                                                                                         Date
If this business is a corporation, an officer or director of the corporation must sign this form.

                                                                                       Continued on the back of the form -                       Continued
                                                                                       Applicants must complete both sides.

                                                   Individual Information is required on all owners of the business**
                                   Last            First                                                             Middle
                                   Name            Name                                                              Initial
                                   Mailing Address
                                   City            State                Zip
                                   Street Address
                                   City            State                Zip
                 Owner Information Work Phone      Social Security No.
                                   Home Phone      Driver’s License No.                                              State
                                   Office or Title       Date of Birth
                                                   Individual Information is required on all owners of the business**
                                   Last            First                                                             Middle
                                   Name            Name                                                              Initial
                                   Mailing Address
                                   City            State                Zip
                                   Street Address
                                   City            State                Zip
                 Owner Information
                                   Work Phone      Social Security No.
                                   Home Phone      Driver’s License No.                                              State
                                   Office or Title       Date of Birth
                                                   Individual Information is required on all owners of the business**
                                   Last            First                                                             Middle
                                   Name            Name                                                              Initial
                                   Mailing Address
                                   City            State                Zip
                                   Street Address
                                   City            State                Zip
                 Owner Information
                                   Work Phone      Social Security No.
                                   Home Phone      Driver’s License No.                                              State
                                   Office or Title       Date of Birth
                                                   Individual Information is required on all owners of the business**
                                   Last            First                                                             Middle
                                   Name            Name                                                              Initial
                                   Mailing Address
                                   City            State                Zip
                                   Street Address
                                   City            State                Zip
                 Owner Information
                                   Work Phone      Social Security No.
                                   Home Phone      Driver’s License No.                                              State
                                   Office or Title       Date of Birth

**Attach additional owner information if necessary.
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