* Required

Business Name
Corporate Name (if applicable)
Business Address (Must be physical location, not a Post Office Box)	Verifying Address... Verified! Not recognized as a valid USPS address. Valid USPS address but is missing UNIT/STE #. Valid USPS address but UNIT/STE # is not recognized. PO Box is not allowed in business address. Verify Address Edit
Mail Address	Same as address above
	Verifying Address... Verified! Not recognized as a valid USPS address. Valid USPS address but is missing UNIT/STE #. Valid USPS address but UNIT/STE # is not recognized. PO Box is not allowed in business address. Verify Address Edit
Business Description
Ownership Type	Corporation Limited Liability Corporation Partnership Sole Proprietorship
Start Date in City of Modesto (estimate if in the future)
Contact Information
Business Phone
Mobile Phone
Fax
Website
Email Address
State Seller's Permit# (required for retail businesses) Example: 123456789-WXYZ
FEIN - ##-#######
SEIN - ###-####-#
Contact Preference	Contact me by email whenever possible, in order to ensure timely notices and help protect the environment by conserving resources.
The SIC Code is a requirement by the State of California, Senate Bill 205. Enter the first 3 characters of your SIC Code or business description in the section below. As you enter the first 3 characters, a list of SIC Codes will appear. Select the one that applies to your business.
SIC Code - Example: Accounting; Contractor; Landscape: Restaurant; etc. If you need help finding your SIC# visit https://www.osha.gov/data/sic-search	Type in at least 3 characters to search for SIC...
State License Information (Contractor, Medical, CAMTC, etc.)
State Contractor License # or Massage Therapist License #
State License Type
State License Expire Date
State License Verification *
Additional Information
Are you operating out of your home? If yes, please fill out the Home Business Agreement. *	---Select---NOYES
Reactivating a previous business license? Please provide your prior Business License #
For contractors only - is this a one time job (OTJ)	---Select---NOYES
If yes, When does the contracted work begin (back date is allowed)?
If yes, What is the end date of contracted work?
If yes, What is the Contracted Amount for this OTJ? This will be used to calculate your license tax due.
OTJ - List the location (address) of contracted job
Are you a business that is a regulated industry with storm water discharge requirements in accordance with the SB205 NPDES permit program? If yes, please provide the Waste Discharge Identification Number below. *	---Select---NOYES
Provide WDID # (If response above is yes) Want to verify if your SIC is regualted visit https://www.waterboards.ca.gov/water_issues/programs/stormwater/sicnum.html
Does your business sell tobacco? *	Yes No
Full Time Employee Count will be provided to Community Economic Development Divison *
File Attachments (if required).
[Required for Sole Owner and Partnership] Provide a copy of your Drivers License or other Gov't Issued Photo ID: Corporations provide a copy of at least one officers Gov't issued Photo ID
File Description
	*This file type is not allowed. List of supported file types.
[Required for Massage Businesses] Please provide a copy of your CAMTC card
File Description
	*This file type is not allowed. List of supported file types.
Other Attachments
File Description
	*This file type is not allowed. List of supported file types.
*Cumulative file size can not exceed 89MB. Please reduce the size of your files and try again.