* Required                

Business Name
Corporate Name (if applicable)
Business Address (Must be physical location, not a Post Office Box)	Verifying Address... Verified! Not recognized as a valid USPS address. Valid USPS address but is missing UNIT/STE #. Valid USPS address but UNIT/STE # is not recognized. Verify Address Edit
Mailing Address	Same as address above
	Verifying Address... Verified! Not recognized as a valid USPS address. Valid USPS address but is missing UNIT/STE #. Valid USPS address but UNIT/STE # is not recognized. Verify Address Edit
Description of Business
Ownership Type	Corporation HOA Ltd Liability Co Ltd Partnership Non-Profit Partnership S Corp Sole Proprietorship Special Event Coordinator Trust
Employee Count *
Start Date in City of Vacaville (estimate if in the future)
Contact Information
Phone
Website
Email Address
FEIN/Tax ID #
SEIN/State ID#
Contact Preference	Contact me by email whenever possible, in order to ensure timely notices and help protect the environment by conserving resources.
State License Information (Contractor, Medical, CAMTC, etc.)
State License #
State License Type
State License Expire Date
State License Verification *
Additional Information
Is this business a registered non-profit? (If yes, you are required to attach your IRS Determination Letter) *	Yes No
Are you a business that is a regulated industry with storm water discharge requirements in accordance with the SB205 NPDES permit program? If yes, please provide the SIC # and Permit # below. *	Yes No
SIC #
NPDES Permit #
Is your business a home-based business in Vacaville? (If yes, the following questions are required to be answered by home-based businesses only) *	Yes No
Days & Times of Operation
Annual Gross Receipts	---Select---Between $1000 - $2500Over $2500Under $1000
Make/Model/License Plate # of each Vehicle
Will you be using a trailer?	Yes No
If Yes, License plate #
What part of the dwelling will be used for the business?
List any equipment/tools used
Describe materials/supplies used and amounts
Where will materials/supplies be stored?	---Select---BothIndoorOutdoor
Describe business related storage
File Attachments (if required).
FILE ATTACHMENT
File Description
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