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Business Name (DBA)
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Corporate Name (if applicable)
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Business Address
(Must be physical location, not a Post Office Box)
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Mail Address
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Business Description
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Ownership Type
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Camarillo based businesses, provide Estimated Gross Receipts for one year of operation. For out of town businesses, Gross Receipts should be reported based on a one year estimate of Gross Receipts for Camarillo business only.
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Start Date in City of Camarillo
(estimate if in the future)
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Contact Information
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Business Phone
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Mobile Phone
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Fax
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Website
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Email Address
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State Resale No.
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Federal Tax I.D. (FEIN)
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State Tax I.D. (SEIN)
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Contact Preference
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| State License Information (Contractor, Medical, CAMTC, etc.) |
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State License #
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State License Type
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State License Expire Date
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State License Verification *
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Additional Information
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Enter number of employees at this location. Each owner/operator should be included in this total.
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SIC # https://www.osha.gov/pls/imis/sicsearch.html
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Are you a business that is a regulated industry with storm water discharge requirements in accordance with the SB205 NPDES permit program? If so, please provide the SIC # and Permit # below.
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Yes No
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NPDES (WDID, NEC OR NONA) Permit #
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File Attachments (if required).
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Copy of Photo ID i.e. Driver's License, Passport, ID Card
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*This file type is not allowed. List of supported file types.
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Required for in-town businesses: Attach Home Occupation Permit or Zoning Approval
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*This file type is not allowed. List of supported file types.
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*Cumulative file size can not exceed 89MB. Please reduce the size of your files and try again.
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