Registration of a Fictitious or Assumed Trade Name: Sole Proprietor

Sole Proprietor Trade Name Application
Clerk of the Circuit Court - Loudoun County, VA

I hereby certify in accordance with the provisions of 59.1-69 of the Code of Virginia that I am conducting a business under the name of at

Street Address	City	State	Zip Code

and the nature of the business is

Name of owner:	First name:	Last name:
Contact Phone:	(10 digits)	Contact Email:
Residence address:	Check here if same as business address, otherwise please enter
	Street address:
	City: State: Zip Code:
Post Office address:	Check here if same as business address, otherwise please enter
	P.O. Box address:
	City: State: Zip Code: