Section A: 

1. Business Name:


2. Local Business Address:
(NO P.O. Box Numbers) City: State: Zip:
Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin

3. Mailing Address:
(if different) City: State: Zip:
(PO Box's Allowed) Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin

4. Email Address:

Check One:

Individual (List Names and Addresses Below)

Partnership (List Names and Addresses Below)

Corporation (List President and Secretary's Names and Home addresses below)

LLC (List President and Secretary's Names and Home addresses below)

Name: Title:
Address:
City: State: Zip:
Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin

Name: Title:
Address:
City: State: Zip:
Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin

Business Phone: Area Code:
Manager's Name:
Manager's Alt. Phone: Area Code:

Does the firm own the building? YesNo
If No, Leased/Rented From:
Date Business started in Greensboro:
No. Employees at this location:
Fiscal year Ends:
Publish on City Website: YesNo

Section C

Please describe your business activities.

Section D

Check each activity that applies to your Business:

Retail Sales	Wholesale Sales
Manufacturing	Service Business
BLDG/Trade Contractor	Vehicle Repair/Service
Food/Restauraunt Servicecs	Beer/Wine Sales
Other (Please Describe Below)

Special Note:

It is understood by the applicant that issuance of a privilege license does not constitute acceptance or approval of the use of the named location as having complied with existing building, zoning or fire prevention codes.   A licensee shall remain fully liable and responsible for bringing the premises into conformity with all applicable city and state codes.

Contact Information

Your name and address may remain anonymous. If you are reporting a problem, it would help us improve, if you at least tell us the street or neighborhood where the problem occurred.

Contact Name: Contact Phone:
Title:

The Privilege License Application process takes 7-10 business days. You should receive a completed application in the mail which will need to be signed and mailed back with your payment before a license will be issued.