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2. Business Registration Type*

   Choose only one

   1. New
   2. Update
3. Business Sticker Number
4. Date of Registration/Update*
   Date of Registration/Update
6. Business Name*
8. Address*
10. City*
11. Zip Code*
13. New Address (if business relocated)
15. New City
16. New Zip Code
18. Phone Number*
19. Fax Number
21. Email Address
23. Owner First Name*
24. Owner Last Name*
26. Owner Home Phone Number*
27. Owner Cell Number
29. Owner Home Address*
31. Owner City*
32. Owner Zip Code*
34. Owner Email Address
38. LIST BELOW THE EMERGENCY CONTACT INFORMATION FOR UP TO 3 BUSINESS CONTACTS (KEY HOLDERS) IN ORDER OF CALL PREFERENCE
40. MAIN CONTACT
42. Name*
43. Email Address
45. Address*
47. City*
48. State*
49. Zip Code*
51. Phone Number*
52. Cell Number
54. SECONDARY CONTACT
56. Name
57. Email Address
59. Address
61. City
62. State
63. Zip Code
65. Phone Number
66. Cell Number
68. THIRD CONTACT
70. Name
71. Email Address
73. Address
75. City
76. State
77. Zip Code
79. Phone Number
80. Cell Number
82. Special Instructions (if any)
84. NOTE: Pursuant to NC General Statutes, Chapter 132, e-mail correspondence to and from this address may be considered public record under the NC Public Records Law and may possibly be disclosed to third parties.
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86. 1. Receive an email copy of this form.
87. Email address

    This field is not part of the form submission.

88. Submit

* indicates a required field