Town of Wyoming BUSINESS NAME:________________________________________________________ BUSINESS ADDRESS:_____________________________________________________ BUSINESS TELEPHONE:_______________STATE LICENSE NUMBER:___________ TYPE OF BUSINESS:______________________________________________________ OWNER’S NAME:________________________________________________________ OWNER’S ADDRESS:_____________________________________________________ OWNER’S TELEPHONE: # OF EMPLOYEES:__________________
****PLEASE ATTACH A CERTIFICATE OF INSURANCE OR HAVE YOUR INSURANCE COMPANY FAX A COPY TO 302-697-7961.**** A BUSINESS LICENSE WILL NOT BE ISSUED UNTIL WE HAVE RECEIVED A CERTIFICATE OF INSURANCE!!!! UPON APPROVAL YOUR TOWN OF WYOMING BUSINESS LICENSE WILL BE VALID THROUGH SEPTEMBER 30, 2010. My signature indicates that I am in compliance with all Town and zoning ordinances and that I am currently licensed by the appropriate state(s). I hereby authorize the Town of Wyoming its agents and/or employees to seek information or conduct an investigation when cause should appear into my criminal background, business practices and other existing licenses I may hold. SIGNATURE:__________________________________________DATE:_____________ OFFICE USE ONLY DATE PAID:____________METHOD:____________CHECK NO:______________ TOWN OF WYOMING LICENSE NUMBER:_________________
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