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2. Applicant
4. Owner Name*
5. Business Name*
7. Trading As Name*
8. Name of Person Completing Application*
10. Mailing Address
12. Address1*
13. Address2
15. City*
16. State*
17. Zip Code*
19. Business Address
21. Street Number*
22. Direction
    -- Select One --ESNW
23. Street Name*
25. Street Type*
    -- Select One --ArchAvenueBoulevardCounty HighwayCircleCreekCrescentCourtDriveGardensHighwayLaneLoopMewsOverlookParkwayPlacePointQuarterRoadState HighwayStreetTerraceWay
26. Suite
27. Floor
29. City
30. State
31. Zip*
35. Additional Information
37. Email Address*
38. Business Phone*
40. Federal ID or Social Security*
    -- Select One --Federal IDSocial Security Number
41. Number*
43. Start Date in Norfolk (MM/DD/YYYY)*
44. Estimated Gross Receipts Jan 1 -Dec 31 (Minimum $1000)*
46. Description of Business Activity (Work performed, serviced provided)*
48. Describe how you will make your revenue (example: products sold, services rendered, commission, fees, etc).*
50. If application is a corporation, list officers and registered agent.
52. President
53. Secretary
55. Treasurer
57. Registered Agent and Contact Address
59. Agent Name
61. Agent Address
Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit Submit and Print

* indicates a required field