Shared Kitchen Space Application Form

Share & Bookmark, Press Enter to show all options, press Tab go to next option
Print
Please correct the field(s) marked in red below:

Instructions:

Thank you for your interest in the Shared Kitchen Space.
It is recommended that you review and gather all documentation prior to beginning the application. Documentation will need to be uploaded before your application is complete.

Required documents are:

  • Verification of Business Existence and Start Date
  • Most Recent Business Federal Tax Return
  • Most Recent Personal Federal Tax Return
  • YTD Profit & Loss Statement
  • Copy of Lease Agreement for any currently occupied space
  • Evidence of all Required Approvals by the Pitt County Environmental Health Department

Please be advised that this application and the information submitted with it are considered to be public records subject to disclosure in accordance with N.C. General Statutes Chapter 132. Information which is considered “trade secret” as defined by law and marked as such (or as “confidential”) may be withheld from public disclosure as provided by law. Questions regarding this application or the application process should be directed to the Purchasing Division at 252.329.4664.


Application approval is contingent upon appropriate approvals from the Pitt County Environmental Health Division following City approval.


 Contact Information


1
Name
 *
2
Position/Title
 *
3
Home Address
 *
4
City
 *
5
State
 *
6
Zip
 *
7
 Business Telephone
 *
8
Mobile Telephone
9
Email Address
 *
10
Social Security Number
 *
11
Do you have another employer? If so, please name.
12
If yes, how many years have you worked for this employer?
Business Information

13
Business Legal Name
 *
14
Business Trade Name
 *
15
Business Address
 *
16
City
 *
17
State
 *
18
Zip
 *
19
Where does your business currently operate?
Where does your business currently operate?
20
Business Start Date
 *
21
Number of Employees
 *
Number of Employees
22
Business Legal Entity
Business Legal Entity
23
Web Site/Social Media
Web Site/Social Media
24
Describe Your Business Including a Brief History and the Products and/or Services You Offer
 *
25
Explain Why You Want to Participate in This Program and How it Will Help your Business Grow.
 *

Documentation

26
Verification of Business Existence and Start Date: This may include Secretary of State, Register of Deeds or other acceptable records that would confirm the existence of your business and its start date.
27
Most Recent Business Federal Tax Return (Tax filings must be Current)
28
Most Recent Personal Federal Tax Return (Tax filings must be Current)
29
Verification of Employee Wages (if applicable)
30
YTD Profit & Loss Statement Through the Most Recently Completed Month
31
Copy of Lease Agreement for any Currently Occupied Space
32
Attach a copy of the menu:
33
Other
  1. To receive a copy of your submission, please fill out your email address below and submit.
    CAPTCHA
    Change the CAPTCHA codeSpeak the CAPTCHA code