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PLC:

a006o2

Agency:

city of crowley

For:

occupational license

Phone:

337-788-4100

Address:

425 n parkerson avenue
crowley, louisiana 70526

*Required Field

Payment Information

*Taxpayer Name:

Middle:

*Last:

*Trade or Business Name:

*Type of License:

*Federal Employee Identification Number:

*Louisiana State Tax Number:

*Acadia Parish Sales Tax Number:

Type of Business:

*Mailing Address:

*City:

*State:

*Zip:

*Physical Address:

*City:

*State:

*Zip:

*Email:

*Phone Number:

(### - ### - ####)

*Driver's License Number:

*State Drivers License Issued in:

*Last 4 digits of Social Security Number:

Is this a NEW BUSINESS. If so, provide the following:

Start Date:

(Month / Day / Year)

Name of Previous Owner if applicable:

*Is this an EXISTING BUSINESS. If so, provide the following:

Amount of Gross Sales:

Please access the link to review and designate the correct Tax Table associated with your EXISTING BUSINESS.

Tax Tables

*Select Correct Table from link above:

*I affirm that the information provided above on this application is true and correct. I acknowledge such as true and correct by selecting the YES box. YES (No other option available other than YES):

Yes

Payment Amount

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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