Business Licence ApplicationBusiness Licence Application
Business Name: _______________________________________________________
Business Identification Number:____________________________________________
Business Address: __________________________________ P.O. Box: ___________
Town: __________________________ Province: _________ Postal Code:_________
Business Phone Number:_____________________ Fax:_______________________
Email : _______________________________________________________________
Applicant(s) Name:______________________ Telephone Number: _______________
Applicant(s) Address: ___________________________________________________
Town: __________________________ Province: _________ Postal Code:_________
Type of Business Licence required:
Home Occupation
New Business
Salesperson
Auctioneer
Kennel
Kennel Renewal
Food Vending Licence
Event Organizer
Pawnbroker
Pawnbroker Renewal
Cost
$140
$140
$205
$205
$100
$100
$205
$205
$205 (including $2000 security deposit)
$65
Proposed date business is to open: ______________________________
Goods to be sold (not applicable to home occupation):_____________________________________
Services to be offered: ______________________________________________________________
For Special Sales, indicate the type of sale (Bankruptcy, fire, etc.): ___________________________
For Special Sales, indicate the amount of merchandise claiming in dollars: _____________________
I, (please print name) _________________________ certify that the information is true and complete
and understand that any false information given will result in termination of the license. I understand
that Building Permits are required for renovations and signage for all businesses.
Signature: ___________________________________ Date: _______________________________
Return completed application to:
Tillsonburg Customer Service Centre
10 Lisgar Ave., Tillsonburg, Ontario N4G 5A5
Phone: 519-688-3009 Fax: 519-688-0759
FOR OFFICE USE ONLY
Date of Payment: ______________________ Roll #_______________________________________
Date Zoning Approval Received from Corporate: _________________________________________
Approval From Building Department: ___________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Approval From Fire Department: ______________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Date Faxed to Board of Health: _______________________________________________________
(Fax #519-539-6206)
Licence # Issued: __________________________________________________________________
Date Sent to Corporate:______________________
Date Mailed:______________________________
Copy circulated to the following departments:
Building
Fire
Police
Tax
Assessment Office
Development Commissioner