WHEN COMPLETED, MAIL TO: CITY OF PHILADELPHIA DEPARTMENT OF LICENSES AND INSPECTIONS DEPARTMENT OF L 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the 'NAME OF OWNER' and 'BUSINESS NAME' fields. Ensure that all names are spelled correctly for accurate processing.
3. Enter the 'BUSINESS ADDRESS', including city, state, and zip code. This is crucial for correspondence regarding your application.
4. Provide your daytime, evening, and fax numbers in the designated fields to ensure you can be reached easily.
5. If your billing address differs from your business address, complete that section as well. Include an email address for digital communication.
6. Fill in the Philadelphia Business Income and Receipts Tax Number and Commercial Activity License Number as required.
7. Attach proof of insurance documentation as specified in the form. This includes worker's compensation and liability insurance details.
8. Complete the applicant certification section by signing and dating where indicated. This confirms your compliance with all regulations.

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