Business Name Business Address Business Type Account #

---Select--- ADMINISTRATIVE OFFICES BACKFLOW TESTERS BANKS/CREDIT UNIONS CAR WASH CHILD ORIENTED BUSINESS CONSULTANT CONTRACTOR - CARPENTRY/CABINET CONTRACTOR - CONCRETE/MASONRY CONTRACTOR - CONST. CLEAN-UP CONTRACTOR - DEMOLITION CONTRACTOR - DRYWALL CONTRACTOR - EARTHWORK & PAVING CONTRACTOR - ELECTRICAL CONTRACTOR - FENCING CONTRACTOR - FIRE PROTECTION CONTRACTOR - GENERAL CONTRACTOR - GENERAL ENG. CONTRACTOR - GLAZING CONTRACTOR - HEATING & A/C CONTRACTOR - INSULATION & ACOUST CONTRACTOR - LANDSCAPE CONTRACTOR - LOW-VOLTAGE SYS CONTRACTOR - ORNAMENTAL IRON CONTRACTOR - PAINTING CONTRACTOR - PARKING & HWY IMPRV CONTRACTOR - PLASTERING/LATH CONTRACTOR - PLUMBING CONTRACTOR - POOLS/SPAS CONTRACTOR - ROOFING CONTRACTOR - SANITATION SYS CONTRACTOR - SHEET METAL CONTRACTOR - SIGN CONTRACTOR CONTRACTOR - SOLAR CONTRACTOR - STRUCTURAL STEEL/WELDING CONTRACTOR - TILE/FLOOR COVERINGS CONTRACTOR OTHER DELIVERY VEHICLE DEVELOPER/BUILDER ENTERTAINMENT - ADULT ENTERTAINMENT - MOVIE THEATRE ENTERTAINMENT - OTHER EQUESTRIAN/HORSE FACILITY GOLF COURSE HOTEL / MOTEL INSURANCE AGENT INSURANCE BROKER MANUFACTURING - OTHER MORTGAGE/LENDING INSTITUTIONS NEWSPAPER/PUBLICATIONS NOT FOR PROFIT-EXEMPT PEST CONTROL PHOTOGRAPHY POSTAL SERVICES PROFESSIONAL - ACCTNG/BOOKKEEPING PROFESSIONAL - ARCHITECT PROFESSIONAL - ATTORNEY/LAWYER PROFESSIONAL - CHIROPRACTIC PROFESSIONAL - DENTAL/ORTHO PROFESSIONAL - ENGINEERING PROFESSIONAL - OPTOMETRY PROFESSIONAL - PHYSICIAN/MEDICAL PROFESSIONAL - VETERINARIAN PROFESSIONAL OTHER PROPERTY MANAGEMENT REAL ESTATE REAL ESTATE APPRAISER RECREATION CONTRACT INSTRUCTOR RETAIL - APPAREL/ACCESS RETAIL - AUTO PARTS/ACCESS RETAIL - BEAUTY SUPPLIES RETAIL - CARDS/GIFTS RETAIL - CELLULAR/WIRELESS RETAIL - CONVENIENCE STORE RETAIL - DEPT STORE RETAIL - DONUTS/BAKERY RETAIL - DRUG STORE RETAIL - ELECTRONICS RETAIL - GEN MERCH RETAIL - GROCERY STORE RETAIL - HOUSEHOLD FURNISHINGS RETAIL - HOUSEWARES/HOME DECOR RETAIL - ICE CREAM TRUCK RETAIL - IMPORT/EXPORT GOODS RETAIL - JEWELRY RETAIL - LIQUOR RETAIL - NUTRITION/HEALTH FOODS RETAIL - PET STORE/SUPPLIES RETAIL - SALE OF FIREARMS RETAIL - SPORTING GOODS RETAIL - TOBACCO SHOP RETAIL - VIDEO RENTAL/SALES RETAIL OTHER SERV - ACUPUNCTURE & REFLEXOLOGY SERV - ALTERATIONS/TAILOR SERV - APPLIANCE REPAIR SERV - AUTOMOTIVE REPAIR SERV - BILLINGS SERV - CERTIFIED MASSAGE CLINIC SERV - DAYCARE SERV - EMPLOYMENT SERVICES SERV - FITNESS CENTER/DANCE STUDIO SERV - FOOT MASSAGE ONLY SERV - GASOLINE SALES SERV - HAIR/NAIL SALON/BARBER SHOP SERV - HOME REPAIR/HANDYMAN SERV - JANITORIAL/CLEANING SERV SERV - LANDSCAPE/GARDENING SERV - LAUNDRY/DRY CLEANERS SERV - MARTIAL ARTS INSTR SERV - MASSAGE CLINIC / DAY SPA SERV - MASSAGE TECHNICIAN SERV - PERSONAL TRAINING SERV - PETGROOMING/BOARDING SERV - POOL/SPA SERVICES SERV - PRINTING/COPYING SERV - REDEMPTION CTR SERV - RESTAURANT SERV - RESTAURANT FAST FOOD SERV - SECURITY PATROL SERV - STYLIST/BARBER/MANICURE SERV - TUTORING/LEARNING CTR SERV - VEHICLE TOWING SERVICE OTHER SOLICITOR WHOLESALE / DISTRIBUTION ---Select--- No Yes