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2. 
3. Privilege License Application
   Please fill out this application if you are conducting business as a facility that sells Beer and/or Wine or a transportation vehicle.
5. Name of Business or Applicant
7. DBA
9. Mailing Address
10. City
11. State
12. Zip Code
14. Business Address
15. City
16. State
17. Zip Code
19. Business Phone#
20. Secondary Phone#
21. Fax#
23. Business Ownership (Corporation, Sole Proprietor, Partnership, Other)
25. Website
27. Contact Person
28. Phone Number
29. Email
31. Nature of business
33. Year business started in Surf City
35. Please check applicable boxes

    1. Beer sold for consumption ON premises
    2. Beer sold for consumption OFF premises
    3. Wine sold for consumption ON premises
    4. Wins sold for consumption OFF premises
37. Transportation Vehicles
39. License Plate #
40. Year
41. Make
42. Model
44. VIN#
46. By digitally printing my name, I affirm, under penalties prescribed by law, that I have examined thsi application and statement; and taht to the best of my knowledge and belief, it is true, complete, and made in good faith for taxable period state pursuant to the Town of Surf City Privilege License Tax Ordinance. A licensee shall be responsible for notifying the Town of Surf City of any changes in location and/or mailing address. It is the responsibility of the licensee to renew the Privilege License prior to expiration.
48. Enter Name
49. Position or Title
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

* indicates a required field