BUSINESS DATA SHEETBUSINESS DATA SHEET
Demographic Survey Data
Number of Rental Properties
in Richmond:
Required:
Business Number:
Company Name:
DBA Name:
Business Mailing
Address
Contact Information
Tax ID (SSN) or (EIN)
Primary Business
Activity Code (PBA)
The six-digit code from
the Principal Business
or Professional Activity
Codes chart.
Gross Receipts:
Enter gross receipts from your trade or
business. (Refer to instructions). Businesses
located outside of the city report gross
receipts tax on work performed within the
boundaries of the city.
Use the space provided below each line if corrections are needed Primary Business Phone Fax Emergency number
Corrected TaxID:
Required:
Required:
Only last four are shown
Contact Name/Address/City/State/Zip
I declare under penalty of perjury that: the information contained in this application is true and correct to the best of my knowledge; that I am licensed or otherwise qualified to conduct the business as described in this application; and that I do not intend or allow criminal activity on the business premises. I agree to comply with all regulations of the Zoning, Building, Fire and all other applicable laws, ordinances and regulations pertaining to the operation of such business. The issuance of a Business Tax Certificate does not constitute the City ’s consent that the holder of such certificate may operate a business in violation of any such codes or Number of Employees
in Richmond:
XSignature
Date
IT-08-21
Primary Contact eMail Required:
M -Male F - Female X -Gender nonconforming O - To be determined Yes - Hispanic or Latino No - not Hispanic or Latino American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White Two or More Races Veteran Disabled Veteran Active
Gender:
Ethnicity:
Race:
Veteran Status:
Required: