City of Radford Virginia
Cathy Flinchum, MCR
Commissioner of the Revenue
619 Second Street, Room 161
Radford, VA 24141

Name of Business

Location of Business

Mailing Address

Class (Motel, Hotel, Rooming House, Bed and Breakfast, etc.)

Contact Person

Home Address of Contact Person

Business Phone

Contact Phone

Business Fax

Contact Email

Type of Ownership (Individual/Partnership/Corporation)

If Corporation - Name of Official Signing

Business Start Date

Name of Business Succeeding (If Applicable)

Name of Bank

Account Number

Signature

Date

Registration must be filed with the Commissioner of the Revenue prior to the opening of the business.
Any changes are to be reported immediately.