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2. 
4. Business Information:
6. Business/Corporate Name:
7. DBA:
9. Owner's name:
11. Organization type:
    -- Select One --Sole proprietorPartnershipIncorporatedCorporationLLC
13. Physical address:
15. Mailing address:
17. Federal ID #:
18. SSN #:
19. State Retail Sales #:
21. S.C. LLR license #
22. Type:
23. Expiration date:
25. Driver's license #:
26. State:
27. Expiration date:
29. Contact name, title:
31. Contact phone:
32. Ext:
33. Email:
35. Landlord/lessor information (in-business city only):
37. Name:
38. Address
40. Classification of business:
    -- Select One --Retail salesRestaurantConstructionService (professional/personal)Service/repairSexually orientedHotel/Motel/Inn/B&BShort-term rentalOther
42. Explain product(s) to be sold and/or services to be provided:
44. OUT OF BUSINESS ONLY: Estimated inside City of Beaufort gross revenue for current year:
46. I certify that the information in this application is correct:
48. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
50. Electronic Signature
51. Date:
55. FOR BUSINESS OFFICE USE:
57. Account #:
58. NAICS:
59. Category:
60. Type code:
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field