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2. Margaret S. Torrence
   Commissioner of Revenue
   Franklin County, VA
   1255 Franklin St., Suite 102
   Rocky Mount, VA 24151
   Phone: (540) 483-3083
   Fax: (540) 483-3089
4. Vendor Type*

   1. Caterer
   2. Convenience Store
   3. Delicatessen
   4. Food Truck
   5. Restaurant
   6. Other
5. List if Other:*
6. Entity Type*

   1. Corporation
   2. LLC
   3. Partnership
   4. Sole Proprietorship
8. Business Name*
9. Trading as Name
11. Contact Person*
12. Virginia State Sales Tax #
14. Business Location Address*
    Enter your street address
16. City*
17. State*
18. Zip Code*
20. Is mailing address same as above?*

    1. Yes
    2. No
22. Mailing Address*
    Enter your mailing address (Number and Street Name or PO Box)
24. City*
25. State*
26. Zip Code*
28. Business Phone*
29. Cell Phone
31. Home Phone
32. Fax Number
34. Email Address
35. Website Address
37. Start Date in Franklin County*
    Start Date in Franklin County
38. At this location
    At this location
42. CONTACT PLANNING & COMMUNITY DEVELOPMENT
    Please contact the Franklin County Planning & Community Development Office at 540-483-3027 to inquire on zoning regulations that may apply to your business.
44. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
46. Electronic Signature
47. Title
48. Date
    Date
50. IMPORTANT MESSAGE: The Commissioner of Revenue office will contact you via phone or email to obtain additional information needed to process this request.
Leave This Blank:


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

    This field is not part of the form submission.

54. Submit

* indicates a required field