APPLICATION FOR BUSINESS LICENSE

CITY OF PLEASANT GROVE

501 PARK ROAD

PLEASANT GROVE, AL  35127

                                                                                               Date:  __________________

Name of Business:  _______________________________________________________

Name of Owner or Principal Officer:  _______________________________________

Address of Business:  _____________________________________________________

________________________________________________________________________

Description of Business Activity:  ___________________________________________

________________________________________________________________________

(Contractors attach copy of Certification if required)

Office or Home Mailing Address:  __________________________________________

________________________________________________________________________

Business Telephone:  ______________________ Home Phone: __________________

DO NOT WRITE BELOW THIS LINE

Annual License  (   )                                                One-Half Annual License  (   )

Total Amount Due:  ______________________   Classification: __________________

Account Number:  ________________________  License Number:  ______________

Date Issued:  _______________________