(Owner SS# required for sole proprietorship, DBA's, & individuals)
(Federal TIN used to file federal tax return)
(as shown on your tax return)
(If different from above - include DBAs here)
(Check all that apply)
Attach Certificate of Liability Insurance OR Completed Independent Contractor Status Form
Attach Certificate of Liability Insurance AND Proof of Workers' Compensation Insurance
- Sole Proprietorship: Enter Owner's Name- Operated as a "DBA:" Enter Business Name- Partnership: Enter name used on tax return
If you have an office or perform a service in the Town of Telluride you must have an active Town of Telluride Business License.
If you do not have an active business license or yours recently expired, please visit bit.ly/totbusinesslicense to complete a Business License Application.
NOTE: It is unlawful for any person to operate any business in the Town of Telluride without a valid business license.
PAYMENTS TO YOU MAY BE WITHHELD UNTIL DELINQUENT BUSINESS LICENSE FEES ARE RESOLVED.
Under penalties of perjury, I herby certify the payee's above TIN is correct, the payee is not subject to backup withholding.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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