City of Page | Business Registration Application

* Required field

Date: *

Business Information:

Legal Business Name: *

DBA Business Name (if different):

Physical Address *

City: *

State: *

Zip: *

Phone *

Email Address: *

Business Type *

Sole Proprietorship

LLC

Corporation

S CORP

LLP

Other

Arizona Transaction Privilege Tax Number (TPT):

Employer Identification Number (EIN):

Mailing Address: *

City: *

State: *

Zip: *

Type of Business or Goods/Wares/Merchandise/Services to be Sold *

Owner Information:

Full Name: *

Mailing Address: *

City: *

State: *

Zip: *

Phone *

Email Address: *

On-Site Manager/Emergency Contact *

Phone *

Alternate Emergency Contact:

Phone

Do You Store Hazardous Materials? *

Yes

If Yes, Please Describe

North American Industry Classification System Code (NAICS)

SOLE PROPRIETORSHIPS/INDIVIDUALS REGISTRATION ELIGIBILITY REQUIREMENT (ARS §41-1080)

Sole Proprietor Registration Eligibility Verification Form

To become eligible for a registration, complete this form and attach a copy of your identification, showing both sides.

Only provide one of the following forms of identification:

*Please note this applies to all "individuals" who obtain licenses and not entities such as Corporations and LLC's

Please attach identification below

#	Item Description		Amount			Subtotal
1	Business Registration Fee		$25.00			$25.00

Total

$25.00

Payment Information

First Name *

Last Name *

Address *

City *

State *

Zip *

Phone *

Email *

Please confirm your signature by typing your full name in the box below.

I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature.

Enter text below. *