Itinerant Business Privilege License Application

 

 

City of Reading Citizens’ Service Center
815 Washington Street

Reading Pennsylvania 19601-3690

(610) 655-6508 Fax (610) 655-6242

www.readingpa.gov Email: csc@readingpa.org
License Fee - $55.00

ITINERANT REGISTRATION QUESTIONNAIRE

 

 

For City Use Only
Prior Year ◻ Itinerant ◻
% of Completion ◻
____________________
Account Number
____________________
Clerk     Date

 

 

The following information is necessary for our records and will be held in strict confidence.

All applicable questions (1-27) must be fully answered and clearly printed.

 

1. Business Name: ____________________________________ 2. FEIN: _________________________
3. Business Phone: _____________________________4. Fax: _________________________________
5. E-Mail:____________________________________6. Website: _______________________________
7. Mailing Address Where all Forms are to be Sent: ________________________________________

 

 

 

8. Start Date of Construction or Business Activity within the City of Reading: _______________________
9. Expected Completion Date of Construction or Activity within the City of Reading (If applicable): ____________________
10. Describe Business Activity/Construction Type: ______________________________________
11. Site of Construction or Complete Work Address Within the City of Reading: ________________

 

 

If You Are Not a Contractor, Skip Questions 12 – 13.
12. Dollar-Amount of Contract: ___________________________________________________________
13. Is Revenue Recognized by Percentage of Completion? ( ) yes, ( ) no. If yes, Enter Projected Revenue Recognition Dates: ______________________________________________________________

 

14.Organization & Type of Business:

 

Proprietorship

       

LLP/LP

       

S-Corp

 

Partnership

       

LLC

 

C-Corp

 

Association

       

Fiduciary

       

Date of Incorporation                       

 

 

15.  Accounting Basis: (    Cash) (    Accrual)                   16. Accounting Year: (    Calendar) (    Fiscal)
17. No. Of Employees (W-2 Recipients*)                            18. Monthly Payroll $                                     
(*W-2s & Monthly Payroll for individual(s) employed at City of Reading job site only)

 

SUBCONTRACTORS

19.  Please list entities who will be hired for this job as Independent Contractors, Subcontractors, or 1099 Recipients. Please use additional sheets if necessary.

 

____________________________________________________________________________________________

CONTACT NAME                                        BUSINESS NAME                                                                       MAILING ADDRESS                                                             TELEPOHNE & E-MAIL ADDRESS

 

____________________________________________________________________________________________

CONTACT NAME                                        BUSINESS NAME                                                                       MAILING ADDRESS                                                             TELEPOHNE & E-MAIL ADDRESS

 

____________________________________________________________________________________________

CONTACT NAME                                        BUSINESS NAME                                                                       MAILING ADDRESS                                                             TELEPOHNE & E-MAIL ADDRESS

 

____________________________________________________________________________________________

CONTACT NAME                                        BUSINESS NAME                                                                       MAILING ADDRESS                                                             TELEPOHNE & E-MAIL ADDRESS

 

____________________________________________________________________________________________

CONTACT NAME                                        BUSINESS NAME                                                                       MAILING ADDRESS                                                             TELEPOHNE & E-MAIL ADDRESS

 

 

 

PLEASE COMPLETE ITEMS #20-23 ONLY IF BUSINESS IS A SOLE PROPRIETORSHIP:

 

20.  Owner’s Name:_______________________________ 21. Owner’s SSN: _______________________

22.  Owner’s Home Address: ___________________________________________________________

23.  Owner’s Date of Birth:                     

(mm/dd/yyyy)

 

 

 

 

 

24.  IF BUSINESS IS A PARTNERSHIP, LLC, LLP, LP, OR CORPORATION (C or S), PLEASE COMPLETE BELOW:

 

Partners’, Members’,
Or Officers’ Names

 

 

Title

Birth
Date

Social Security
Number

Home
Address

 

 

 

 

25.  Name of Previous Owner (If Any):__________________________________________________

26.  Previous Business Address (If Any):_______________________________________________

 

 

 

 

 

27.  I Hereby Certify That All Information And Statements Herein Are True and Correct.

 

If this form is not signed in the Cit i ze ns Se rv i c e  Ce nt e r  it must be NOTARIZED.

 

X_____________________________________________________________________________________

Proprietor/Partner/Member(s)/Officer(s) Signature                                                                 Date

 

X_____________________________________________________________________________________

Partner/Member(s)/Officer(s) Signature                                                                                   Date

 

NOTE:  The facts set forth herein are made subject to the penalties of 18 PA C.S._Sec. 4904 relative to unsworn falsifications to authorities.

 

*If Business Is A Partnership, All Partners Must Verify Questionnaire Either By Personal Appearance At This Office For The Purpose Of Signing This Questionnaire Or By Separate Notarized Statement.