CITY OF DELTA 
                        SALES AND USE TAX LICENSE  

                                              APPLICATION 
 
1.  Is this an application for a (CHECK ONE):                                                 Permanent business location 
                                                                                              Temporary or door-to-door business 
                                    (IF TEMPORARY INDICATE DATES OF OPERATION): From                           To                           
                                        
2.  Estimate of monthly taxable sales: $                           
 
3.  Number of employees within the municipality:                           
 
4.  Type of ownership:          Individual/Proprietorship         Partnership         Corporation 
                                Association/Club         Other (PLEASE SPECIFY)                                                 
 
5.  Federal Employer Identification Number or Social Security Number:                                                        
 
6.  License to be issued in the name of (LIST FULL LEGAL NAME OF INDIVIDUAL/PROPRIETOR, PARTNERSHIP, CORPORATION, 
OR ASSOCIATION/CLUB):                                                                                                                                                   
                                                                                                                                                                              
7.  Trade name (d/b/a/):                                                                                                                                           
 
8a.  Mailing Address:                                                                                                                                          
                                        Street                           City                         State             Zip Code 
 
8b.  Business is conducted at:                                                                                                                             
                                        Street                           City                         State             Zip Code 
 
8c.  Business phone number:  (      )                                8d.  Business fax number:  (      )                               
 
8e.  Is your business located in a:                                            Commercial establishment         Private residence 
                                                                                Other (PLEASE SPECIFY)                                                   
 
9.  Name all principal owners or officers: 
 
            Name                                                      Home address                    Home phone 
                                                                      
            Title                             
                                                                                                                                                                              
            Name                                                      Home address                    Home phone 
                                                                      
            Title                             
                                                                                                                                                                              
            Name                                                      Home address                    Home phone 
                                                                      
            Title                             
                                        (PLEASE COMPLETE REVERSE SIDE OF APPLICATION) 
                                                                         

10.  Date you began or will begin business activity in the municipality:                                                            
                             
11.  List product that you sell or service that you provide (PLEASE BE SPECIFIC):                                                   
                             
12.  Landlord:                                                                                                                                                      
                Name         Address                                             Phone 
13.  Accountant:                                                                                                                                                  
                Name         Address                                             Phone 
 
14.  Location of business records:                                                                                                                       
                             Address                                             Phone 
 
A.  This application for a Sales and Use Tax License will be rejected if all questions are not 
fully answered. 
 
B.  This application for a Sales and Use Tax License will be rejected if it is not accompanied 
by a $10.00 license fee. 
 
C.  This is only a sales and use tax license application form.  The submission of a completed 
version of this form and issuance of a Sales and Use Tax License may be only one of the 
steps that you must complete before you are legally authorized to engage in business in the 
Municipality.  It is your responsibility to contact the Municipality and assure that you have 
complied with all applicable legal requirements in addition to obtaining a Sales and Use Tax 
License prior to engaging in business in the Municipality.      
 
15a.  Signature of applicant:                                                                                15b.  Date:                              
 
15c.  Print name and title of signature of applicant:                                                                                          
 
                          O F F I C E   U S E   O N L Y 
                          (DO NOT WRITE IN THIS SPACE) 
                             
LICENSE NUMBER:                                                DATE OF ISSUANCE:                                                   
 
INDUSTRY:                            GEOGRAPHIC:                            FILING FREQUENCY: