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2. 
3. Date
   Date
5. Business Name
6. Telephone Number
8. Business Address
10. Address2
12. City
13. State
14. Zip
16. Contact Person
17. Telephone Number
19. Registration Holder Name
20. Email Address
22. Registration Holder Address
24. Address2
26. City
27. State
28. Zip
30. Inspection Type
31. License Number
32. Expiration Date
34. Driver's License Number
35. Date of Birth
36. Federal Employer ID Number (or reason for exemption)
38. Qualifications
40. Certifications
42. Applicant's Email Address *Required*
44. By electronically signing this application, I certify that I will take responsibility for the inspection performed pursuant to the business using my business name. I agree to cooperate with all inspectors and agree to conform to all applicable laws of the City of Sterling Heights. All information submitted on this application is accurate to the best of my knowledge.
46. First Name
47. Last Name
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49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field