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2. Applicant
4. Owner/Business Name*
5. Name of Person Completing Application*
7. Trading As Name*
8. Please select an option to receive your License:*
   -- Select One --In PersonEmailUSPS
10. Mailing Address
12. Address1*
13. Address2
15. City*
16. State*
17. Zip *
19. Business Address
21. Location Address*
22. Suite
24. City*
25. State*
26. Zip*
30. Additional Information
32. Email Address*
33. Business Phone*
35. Federal ID or Social Security*
    -- Select One --Federal IDSocial Security Number
36. Number*
38. Description of Business Activity (Work performed, serviced provided)*
    -- Select One --Non-Food Vendor - Merchandise - $50 - 999100-01Non-Food Vendor - Games, Rides, etc. - $50 - 999100-01 (10% admission tax required)Food / Beverage Vendor - Sold prepackaged - $50 - 999101-01 (Food & Beverage factory sealed)Food / Beverage Vendor - Prepared Foods/Beverages - $50 - 999101-01 (6.5% Meals Tax required)Itinerant Merchant or Show Performer - $500 - 999300-01Scope Promoter - Call for details - 999300-02 (Umbrella business license, Norfolk Scope Facility only)
40. Event Name:*
41. Event Date:*
43. Event Name:
44. Event Date:
46. Event Name:
47. Event Date:
51. This information is true and correct to the best of my knowledge.
52. Acknowledgement*

    1. By checking this box you understand this statement.
54. Name:*
55. Title:*
56. Date:*
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit Submit and Print

* indicates a required field