Lodging Registration

Name of Business*
Telephone Number*
Virginia Sales Tax #
FEIN
E-mail Address*
Owner
First Last
Type of Ownership
Business Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address*
Same as Business Address

Street Address Address Line 2 City State ZIP Code
If Corporation - name (s) of signing officials
First Last
Add another signing official
Add another signing official
If Corporation - name (s) of signing officials
First Last
Date started or start date at this location
MM slash DD slash YYYY
Sign Here*
First Last
Consent*
I agree to electronically sign and to create a legally binding document between the other party and myself, or the entity I am authorized to represent.*