Change of Information Form

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Please correct the fields below:

Please correct the field(s) marked in red below:

This form is to be used if your business name, physical business location, mailing address or contact information has changed since your last application for an Occupation Tax Certificate was received by the City of Roswell.

If your physical business location has changed, you must submit a new lease agreement and obtain approvals from our Fire, Building and Zoning departments for the new location before a new certificate can be issued.

If you have any questions, please contact the Roswell Business Registration Division at businessregistration@roswellgov.com or 770-594-6235.

Current Account Information

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Current Account Information

Business License Number:

Federal Tax ID Number:

Date Requested:

Effective Date of Change:

Phone Number:ext.

Email Address:

Name of Business:

Business Description:

Requestor Name/Title (Must be on account):

Please check appropriate box and note changes below:

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Please check appropriate box and note changes below:

Business Name

Business Location

Business Mailing Address

NAICS Classification

Contact Information

Requested Change:

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Requested Change:

Acknowledgement and Confirmation

I declare under penalty of making false declaration, that I am authorized to complete this form and to the best of my knowledge and belief, it is a true, correct and complete statement made in good faith.

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Acknowledgement and Confirmation I declare under penalty of making false declaration, that I am authorized to complete this form and to the best of my knowledge and belief, it is a true, correct and complete statement made in good faith.

Signature (Please type your full name in lieu of your signature):

Title:

Date:

To receive a copy of your submission, please fill out your email address below and submit.
Email Address