|
DBA
|
|
Bus Name
|
|
Bus Address
(Must be physical location, not a Post Office Box)
|
|
|
|
|
Mail Address
|
|
|
|
|
|
|
Description of Work
|
|
Ownership Type
|
|
Employee Count
*
|
|
Start Date in City of Alameda
(estimate if in the future)
|
|
Contact Information
|
Phone
|
|
Phone 2
|
|
Fax
|
|
Website
|
|
Email Address
|
|
BEAN
|
|
FEIN
|
|
SEIN
|
|
Contact Preference
|
|
State License Information (Contractor, Medical, CAMTC, etc.) |
State License #
|
|
State License Type
|
|
State License Expire Date
|
|
State License Verification *
|
|
Additional Information
|
Please enter estimated Gross Receipt for the first 12 months of operation (Cannot be $0)
*
|
|