Spreadsheet: 704a61c2-667c-414b-9fcf-395287869df4
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | City of Rio Rancho - Office of the City Clerk Application for Business Registration 3200 Civic Center Circle NE, Rio Rancho, NM,  87144 Phone: (505) 891-5004 ● Fax: (505) 994-2557 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Unnamed: 24 | Unnamed: 25 | Unnamed: 26 | Unnamed: 27 | Unnamed: 28 | Unnamed: 29 | Unnamed: 30 | Unnamed: 31 | Unnamed: 32 | Unnamed: 33 | Unnamed: 34 | Unnamed: 35
Please complete all the information on this form as completely and accurately as possible by typing or using blue or black ink.  Please contact us at (505) 891-5004 with any questions.
SECTION 1 - BUSINESS INFORMATION |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | FEE: $35.00
Type of Business: |  |  |  |  |  |  |  | Commercial |  |  |  |  |  |  | Home Occupation |  |  |  |  |  |  |  |  | Non-Profit |  |  |  |  |  |  | Out of City
Business Name:
Primary Contact:
 |  |  |  |  |  |  |  | First Name |  |  |  |  |  |  |  |  |  | Last Name |  |  |  |  |  |  |  |  |  | Title
Physical Address:
 |  |  |  |  |  |  |  | Street |  |  |  |  |  |  |  |  |  |  |  |  |  |  | City/State |  |  |  |  |  |  |  |  | Zip
Mailing Address:
 |  |  |  |  |  |  |  | Street |  |  |  |  |  |  |  |  |  |  |  |  |  |  | City/State |  |  |  |  |  |  |  |  | Zip
Phone #: |  |  |  |  |  |  |  |  |  |  |  |  |  |  | E-Mail:
[NAME]
NM CRS/TAX ID NUMBER
Type of Ownership:
 |  |  |  |  |  |  |  |  |  |  |  |  |  | Corporation/LLC/Partnership/Sole Proprietor/Non-Profit/Etc.
Nature of Business:
Primary Business Type:
 |  |  |  | Construction |  |  |  |  |  |  |  | Manufacturing |  |  |  |  |  |  |  | Retail |  |  |  |  |  |  |  | Wholesale Trade
 |  |  |  | Personal Service |  |  |  |  |  |  |  | Business Service |  |  |  |  |  |  |  | Other (Please specify:)
SECTION 3 - CORPORATE PERSONNEL
Owner/CEO:
 |  |  |  |  |  |  |  | First Name |  |  |  |  |  |  |  |  |  | Last Name |  |  |  |  |  |  |  |  |  | Title
Physical Address:
 |  |  |  |  |  |  |  | Street |  |  |  |  |  |  |  |  |  |  |  |  |  |  | City/State |  |  |  |  |  |  |  |  | Zip
Other Officer:
 |  |  |  |  |  |  |  | First Name |  |  |  |  |  |  |  |  |  | Last Name |  |  |  |  |  |  |  |  |  | Title
Physical Address:
 |  |  |  |  |  |  |  | Street |  |  |  |  |  |  |  |  |  |  |  |  |  |  | City/State |  |  |  |  |  |  |  |  | Zip
CITY OF RIO RANCHO - APPLICATION FOR BUSINESS REGISTRATION
PAGE 2
[NAME]
1.  Have You Completed the Wastewater Survey? |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes |  |  |  | No
 |  |  |  | (Not applicable for home-based businesses)
2.  Do you Handle Hazardous, Toxic, or Radioactive Materials? |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes |  |  |  | No
3.  Does Your Business require Any of the Following Permits/Licenses:
 |  |  | New Mexico Environment Department Food Permit
 |  |  | Federal Environmental Protection Agency Permit(s)
 |  |  | A Contractor's License Issued by the state of New Mexico
 |  |  | Medical/Pharmaceutical License(s)
 |  |  | Other state or federal license (please specify):
 | If you answered yes to any of the above, please attach a copy of the permit/license.
SECTION 5 - SIGNATURE OF APPLICANT
By signing this form, I attest that the information I have provided herein is true and accurate to the best of my knowledge.  I certify that I am authorized to sign the same as an agent on behalf of the above stated business.  I agree to pay all associated fees for my registration including: the annual business registration fee, applicable fire inspection fees, and other applicable permit fees as required by the city of Rio Rancho.  I understand that I must file any changes to my business status, operations, and/or contact information with the City Clerk’s office in a timely manner.
Signature: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date:
 |  |  |  | Must be an  owner, partner, or corporate officer of the organization
Printed Name: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Title:
SECTION 6 - APPROVALS (CITY USE ONLY)
Zoning Approval: |  |  |  |  |  |  |  |  |  | Approved |  |  |  |  |  |  |  |  | Not Approved |  |  |  |  |  |  |  |  |  | Current Zoning
[NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date
Fire Inspection: |  |  |  |  |  |  |  |  |  | Approved |  |  |  |  |  |  |  |  | Not Approved |  |  |  |  |  |  |  |  |  | Date of Inspection
Rio Rancho Fire Marshall |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date
Building Inspection: |  |  |  |  |  |  |  |  |  | CO Approved |  |  |  |  |  |  |  |  | CO Not Approved |  |  |  |  |  |  |  |  |  | Date of Inspection
Building Inspection Division Manager |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date
Once completed, please return this form to the Office of the City Clerk:                                    3200 Civic Center Circle NE, Rio Rancho, NM  87144. (Rev. 1-13)