NAME OF
APPLICANT__________________________________________________________ |
APPLICANT'S
HOME ADDRESS___________________________________________________ |
CITY &
STATE
________________________________________________________________ |
SOCIAL SECURITY
NUMBER ____________________________ |
DATE OF BIRTH
______________________________________ |
IF A
CORPORATION, GIVE NAME OF
CORPORATION__________________________________ |
APPLICANT'S
TITLE IN CORPORATION _____________________________________________ |
FEDERAL
TAXPAYER I.D. NUMBER OF
CORPORATION_________________________________ |
NEW JERSEY
STATE SALES TAX CERTIFICATE NUMBER _______________________________ |
TRADE NAME OF
BUSINESS ______________________________________________________ |
BUSINESS
ADDRESS
_____________________________________________________________ |
BUSINESS
TELEPHONE _______________________________ |
HOME TELEPHONE
# _________________________________ |
ALL COIN
OPERATED VENDING MACHINES MUST BE LICENSED. |
IF ANY ARE
LOCATED WITHIN YOUR ESTABLISHMENT, LIST THE OWNER OF THE VENDING MACHINES.
_____________________________________________________________________________
_____________________________________________________________________________ |
|