Business License Application

Type of Application

New Business

Corporation

Individual

Partnership

Business Name

Federal Tax ID/EIN Number

Mailing Address

City

State

Zip

Physical Location of Business

Business Web Address

Name of Point of Contact

Local Phone Number

Fax

Home Office Phone Number

Type of Business

Total Gross Receipts / Contract Amount $

From

If more than one class rating, please explain the fee calculation.

Business License Fee $

Amusement Machine Fee $

Number of machines x $12.50

Pool Table Fee $

Number of tables x $12.50

Penalty %

Express Permit $

Total Fee Due $

Business Owner Name

Address

City

State

Zip

Certification of Applicant

I agree

I disagree

I (we) do hereby certify that the information given in this application is true. That the gross income is accurately reported or estimated for a new business without any unauthorized deduction, and that all assessments and personal property taxes due and payable to the city have been paid. I understand that issuance of a city business license does not relieve me of the responsibility of meeting all City of Goose Creek Zoning and Building Code requirements, and that I am subject to all provisions of the business license ordinance of the City of Goose Creek. I also understand and authorize the City of Goose Creek and it’s Agents to utilize all information on this application for the purposes of obtaining a business license and insuring that all other federal, state, and local laws are followed.

Date

Name of Owner or Authorized Agent

Title

If you would like to receive an emailed copy of this form, please enter your email address.

The City of Goose Creek has the right pursuant to the SC Debt Collection Act to collect any delinquent sum due through offset of the state income tax refund including all fees.

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