Springfield Business License Application

General Business Information

License Type*

select

Business Name*
DBA
Attention
Physical Address
(Cannot be a P.O. Box)*
City* State* Zip*

Mailing Address same as Physical Address

Mailing Address *

Mailing City* Mailing State* Mailing Zip*

Business Phone*

Enter the number of units*

Date(s) of Sale*

Days and Hours of Operation*

Please upload Certificate of Liability Insurance*

Please upload Picture(s) of Vehicles*

Please upload Plot Plan*

Please upload Certificate of Insurance*

Please upload Picture of the mobile unit being used*

Please upload Floorplan of mobile unit*

Please upload Written property owner's permission*

Please upload Discharge Plan Narrative*

Please upload your current food handlers card*

CONTACT INFORMATION

Primary Contact

Primary Contact*
Phone* Secondary Phone
Email*

Please upload a copy of your driver's license*

Installation was for* Business Residence

Business Owner

Business Owner's Full Name*
Business Owner's Mailing Address*
City* State* Zip*
Phone* Email*

Alarm Business License #*

Do you own or lease the property*

Own Lease

Certification/Signature

By submitting this application, I , declare under penalty of perjury, under the laws of the State of Oregon, that the above application is true and correct to the best of my knowledge. I certify that I will operate my business in accordance with all applicable federal, state and local laws and regulations. I further understand that any false statements made above are grounds for denial or revocation of the business license.

Executed the .

Please sign your name below, using the mouse or your touch screen enabled device. To use mouse, left click and hold while dragging the mouse over the signature line.

General Business Information

CONTACT INFORMATION

Primary Contact

Business Owner

Property Owner

Certification/Signature