Application

Check all that apply:
Sole proprietor
Partnership
Public corporation
Franchise
Nonprofit/government
Private corporation State

1. Number of proposed locations
   
2. Address of each location (Attach as a separate sheet)

3. Please complete the following:

1. Subway station & routes (s)
   
2. Bus stop & route(s) (specify if NYCT or private):
   
   
3. Nearest intersection
   MTA's priority area code
   
4. Neighborhood


5. Zoning: Select One Business District Industrial Residential Open Space/Recreational


6. Location: Select One Street Shopping Center Mall Newsstand Other
   if other please specify
   
7. Business Type: Select One Association Bakery, Candy Store Bank Beauty Shop Book Store Check Casher College Communication, Multi-Service Convenience Store Deli Discount Store Drug Store, Pharmacy Gas Station Gift Shop Hospital Hotel Laundromat Music Store Newsstand NYC Agency Photo Shop Restaurant Retail Store School Stationery Super Market Tourism Other
   

1. Business Name
   Product/Service Purchased
   Contact Account Number
   City State Zip Phone

2. Business Name
   Product/Service Purchased
   Contact Account Number
   City State Zip Phone

3. Business Name
   Product/Service Purchased
   Contact Account Number
   City State Zip Phone

Principal(s) Operate/Manage Business? Select One Yes No

1. Officer Name Title
   Current Home Address Phone
   City State Zip
   

2. Officer Name Title
   Current Home Address Phone
   City State Zip