TUSCALOOSA COUNTY SPECIAL TAX BOARD

P O BOX 20738

TUSCALOOSA, AL 35402-0738

PHONE: 205-722-0540

Fax: 205-722-0587

APPLICATION FOR SALES OR USE TAX ACCOUNT

NEED A COPY OF OWNER’S OR ALL OFFICERS’ DRIVERS’ LICENSES

STATE OF ALABAMA TAX#____________________________________________________

FULL LEGAL NAME (SAME AS REGISTERED WITH THE STATE):

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NAME OF BUSINESS (DOING BUSINESS AS):

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TYPE OF BUSINESS: ___________________________________________________________

MAILING ADDRESS:

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PHYSICAL ADDRESS (IF MORE THAN ONE LOCATION, PLEASE LIST ALL):

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PHONE NUMBER: _________________________ FAX: ______________________________

CELLULAR NUMBER: _____________________ EMAIL: ___________________________

DATE OF BIRTH OF OWNER OR ALL OFFICERS, PARTNERS, ETC: _______________________________________________________________________

NAME OF CONTACT PERSON: __________________________________________________

BUSINESS START DATE IN TUSCALOOSA CO: ___________________________________

BUSINESS OWNERS NAME OR IF PARTNERSHIP, OR CORP. GIVE NAME, ADDRESS & PHONE NUMBER OF EACH OFFICER:

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SIGNATURE: _________________________________________________________________