Alabama Fire Marshal's Office

*All fields are required

Renewal

Initial

Invalid Permit Number

First Name:
*

Last Name:
*

Race:
Race Caucasian African American Hispanic Asian Pacific Islander Native American Alaskan Native Other

Gender: *

Male

Female

Date of Birth:
*

Social Security Number:
* *

Email Address:
* * Permits will be sent to this email address

Renewal Email Address:
* * Renewal reminders will be sent to this address.

Name of Business:
*

Business Federal ID:
* *

Business Phone:
*

Business Mailing Address:
*

City, State, Zip:
State ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA CANADA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING * * *

Business Physical Address:
*

City, State, Zip:
State ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA CANADA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING * * * *

1) Has this Contractor ever been licensed by this office before? *

Yes

No

2) Is this contractor under indictment or information for, or have been convicted in any court of, a crime punishable by imprisonment for a term exceeding one(1) year? (Charges May include, but are not limited to, crimes involving drugs, burglary, robbery, murder, manslaughter, and explosives or firearms violations.) *

Yes

No

3) Has this contractor ever been charged with or convicted of a crime involving the illegal use of explosives? *

Yes

No

4) Is this contractor a fugitive from justice? *

Yes

No

5) Is this contractor unlawful user or addicted to the use of alcohol, narcotics or dangerous drugs? *

Yes

No

6) Has this contractor ever been adjudicted mentally defective or committed to a mental institution? *

Yes

No

7) Is this contractor a United States citizen? *

Yes

No

8) Has this contractor been discharged from the armed forces under dishonorable conditions? *

Yes

No

9) Has this contractor ever renounced his/her United States citizenship? *

Yes

No

10) Do you store explosives? *

Always

Occasionally

Never

I hereby certify that the information provided herein is true and correct.