Total of Lines 3 & 4
Processing Fee
Total of Lines 5 & 6
BUSINESS LICENSE APPLICATION
(COMMERCIAL PROPERTY RENTAL APPLICATION)
CITY OF WEST COVINA
1444 W. Garvey Ave. • P. O. Box 1440 • West Covina, CA 91793
Attn: Bus. Lic. Dept. • (626) 939-8447 • Fax (626) 939-8664 • www.westcovina.org
Enter below names of Owners, Partners, Corporate Officers or Principals - Use additional sheets as necessary. Please note, the first two names listed will
appear on the business license certificate.
I declare, under penalty of perjury, that the information in this
application is true and correct to the best of my knowledge.
Owner Name
Title
Phone ( )
Home Address
Cell Phone ( )
City
State
Zip
Soc. Sec. No.
Driver’s License No.
Thank you for doing business in the City of West Covina
$67.00 for the first $5,000.00
Gross Receipts
$10.00 for each additional
$1,000.00 Gross Receipts
(Over $5,000.00)
Sub-Total of Lines 1 & 2
Penalty (if applicable)
On the reverse side, list the correct street address, business
name of tenant from all commercial rental in the City of West
Covina. New commercial property owner pays $67.00 on the
first year of business. The balance is calculated and payable
at the end of the calendar year.
IMPORTANT
TOTAL YEARLY GROSS RECEIPTS:
Please Check One:
• OFFICIAL USE ONLY •
NEW APPLICATION
CHANGE OF OWNER
CHANGE OF ADDRESS
CHANGE OF BUSINESS NAME
CASH
LICENSE NO.
EXPIRATION DATE
DATE PAID
CHECK NO.
CREDIT CARD
BATCH NO.
Business Name
Business Location
(Not P. O. Box)
Mailing Address
(If Different)
City
State
Zip
City
State
Zip
Bus. Phone ( )
Bus. Fax ( )
E-Mail Address: _________________________________________________ Website: _____________________________________________
PLEASE RETURN ENTIRE APPLICATION FORM TO ABOVE ADDRESS
1)
2)
3)
4)
5)
6)
7)
Date:
Title:
Signature:
Description of Business:
Start Date in West Covina:
Owner Name
Title
Home Address
City
State
Zip
Phone ( )
Soc. Sec. No.
Driver’s License N