For Help Call  510-792-8992 
Fields marked (*) are mandatory.
Name of Applicant*
Street Address*
City*
State*
Zip Code*
Proposed Effective Date*
F.E.I.N. or SSN (optional)
Phone*
Fax
Email*
Website address
General Business Information
Inspection Contact Name
Inspection Contact Phone
Accounting Contact Name
Accounting Contact Phone
Number of Years in Business
Date Business Started
Description of Business
Opt me in text messages*