Change of Information Form

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.

Note: If your physical business location has changed, there is a $75 fee and 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 via email or (770) 594-6235.

Company

This field is for validation purposes and should be left unchanged.

Business License Number(Required)

Federal Tax ID Number(Required)

Date Requested (MM/DD/YYYY)(Required)

Effective Date of Change (MM/DD/YYYY)(Required)

Phone Number(Required)

Email Address(Required)

Name of Business(Required)

Business Description(Required)

Requestor Name(Required)

Must be on account

First Last

Title

Please check appropriate box and note changes below:(Required)

Business Name

Business Location

Business Mailing Address

NAICS Classification

Contact Information

Requested Change(Required)

Signature (Full Name)(Required)

Title

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