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Business Information (all fields required) NAME OF BUSINESS TRADE NAME / DBA (if different from Name of Business) BUSINESS LOCATION ADDRESS (No PO Box) CITY STATE ZIP+4 MAILING ADDRESS CHECK BOX IF ADDRESS IS THE SAME AS ABOVE CITY STATE ZIP+4 PLEASE ENTER DETAILED BUSINESS DESCRIPTION (SPECIFY ITEMS SOLD AND/OR SERVICES PERFORMED): DAYS & HOURS OF OPERATION: LIST HAZARDOUS MATERIALS STORED ON-SITE (NOTIFY PLEASE LIST A MANAGING AGENT RESPONSIBLE FOR THE LICENSEE’S COMPLIACE WITH TITLE 5 OF THE MONUMENT MUNICIPAL CODE (REQUIRED) FEIN OR EIN (Tax ID COLORADO SALES TAX NUMBER (or write “service industry” if applicable) TYPE OF BUSINESS (Check all that apply) Retail Communications Wholesale Medical Manufacturing Mail/Internet Order Service Leasing Construction Restaurant Home Occupation Office Only Ownership Information (all fields required) OWNER NAME OWNER PHONE OWNER OR BUSINESS EMAIL OWNER’S RESIDENTIAL ADDRESS CITY STATE ZIP+4 COMPLETE THE FOLLOWING FOR EACH OWNER, PARTNER, MEMBER, OR OFFICER NOT LISTED ABOVE: (Use additional sheet if necessary) NAME PHONE EMAIL RESIDENTIAL ADDRESS CITY STATE ZIP+4 EMERGENCY AFTER HOURS CONTACT(S): NAME/POSTION: PHONE: NAME/POSTION: PHONE: NAME/POSTION: PHONE: ALARM COMPANY AND PHONE NUMBER: TYPE OF OWNERSHIP (Check all that apply) INDIVIDUAL PARTNERSHIP LLP or LLLP LLC CORPORATION NON-PROFIT OTHER (LIST) Applicant Signature I, as the applicant, affirm under penalty of perjury, that I have read and understand the Business License Application; that I have not engaged in false or misleading advertising, falsified any business records, or participated in any unlawful business practices in a similar business; have not had a similar type business license revoked or suspended in this or any other locality in the twelve (12) months immediately preceding the date of the application; and the business, premises, building or land use complies with the requirements of the Town codes or entities having jurisdiction over activities conducted within the Town limit. I further affirm under penalty of perjury, that this application has been examined by me; that the statements made herein are made in good faith and, to the best of my knowledge and belief, are true, correct and complete; and that I am qualified under Federal or State law to engage in the activity authorized by the license. APPLICANT’S SIGNATURE PRINTED NAME DATE Check this box if you would like to receive emails with Town of Monument news and information. FOR TOWN USE ONLY Application For One of the Following: (check 1) New Business License ($75 Annual Fee) Renewal of Existing Business License ($75 Annual Fee) Non-profit Organization (Proof of Non-profit Status Required) Address Change for Existing License (No Fee) Supplemental Documents: (check if applicable) Business Premise Form (Required if physically located in Town) Home Occupation Agreement (Required for all home occupations) Temporary Use Permit (Required for Mobile Vendors) DATE: LICENSE No. Fee received: CHECK CREDIT CARD CASH RECEIVED BY ZONING DATE APPROVED: Town of Monument Business License Application 645 Beacon Lite Rd., Monument CO 80132 [PHONE REDACTED] www.townofmonument.org