Business License Application

Required fields are marked with asterisks (*)

City of Lemon Grove

Instructions: Please fill out this form completely. A printed or typed response is recommended. Sign and return to the address on the last page by email, fax, mail or in person. If you need an accommodation to complete or submit this form, please contact the License Clerk at samavisca@lemongrove.ca.gov

Business Name

Street Address:

City, State

Zip Code

Telephone:

fax#

E-mail address

Ownership

Corporation

LLC

Partnership

Sole Proprietorship

Trust

State License No.

License Type

Expiration Date

Resale No.

Federal I.D No.

State I.D. No.

Owner Name

Title

Phone

Address:

City, State

Zip Code

Owner Name

Title

Phone

City, State

Zip Code

Contact in case of emergency (Name and phone)

Alarm Company (if applicable)

Address:

City, State

Zip Code

Telephone:

License No.

I declare under penalty of perjury that to the best of my knowledge and belief the statements made herein are true and correct.

Clear

FOR OFFICIAL USE ONLY

Name as it appears on the credit card

Account Number

Expiration Date:

CVV

Authorized Amount:

Return to:

Serena Amavisca
License Clerk
City of Lemon Grove
3232 Main Street
Lemon Grove, CA 91945
Phone: (619) 825-3800
Email: samavisca@lemongrove.ca.gov