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Online Services
Animal Shelter
View Lost and Found Pets
View Pets for Adoption
Assessor
Assessment Roll
Building
Make a Reservation
Accessory Apartment - House Rental Search
Renew Your Rental License
Building Permit Renewal
Economic Development
Business Expo Payment
Job Fair Payment
Fire Prevention
Commercial Property Registration
Online Payments
Highway
Family Pet Walk
Tree Inspection Request
Report Traffic Safety Problem
Holiday Light Spectacular
Housing
Apply for Home Repairs
ReGeneration Summer Camp
MLK Luncheon
Law
Report a Housing Related Issue
Report a Vacant Home
Online Records Request
Parking Violations
View / Pay Parking Ticket Online
Parks
Register Your Baseball Team
Parking Sticker
Non-Resident Parking Stickers
Personnel
Apply for a Seasonal Job
Planning Department
View Historic Districts / Landmarks Information
View Zoning Information
Public Information
Get Channel 18 Cable Schedule
View GIS Maps
Watch Channel 18 On Demand
Purchasing
Bids and RFPs
Receiver of Taxes
Tax Portal
Recycling and Garbage
Find Glass Recycling Locations
View Garbage Pickup Days
View Garbage Pickup Days on a Map
Great Brookhaven Clean Up Signup
Request a Paper Recycling Bin
Senior Citizens
Apply for Transportation Services
Town Clerk
Apply for a Dog License
Marina Wait List Application
Obtain Marriage, Birth, and Death Certificates Online
View Marina Wait List
Marriage License Application
Confirmation
Vehicle Control
Report an Abandoned Vehicle on a Town Road
Women's Services
Sign Up for Our Women's Conference and Expo
Submit a Nomination for Our Women's Recognition Awards
View Women's Referral Agencies
Youth Bureau
Request to Join Our Youth Board
Submit a Nomination for Our Youth Volunteer Awards
Home
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Expeditor Registration
EXPEDITOR ONLINE REGISTRATION
Please fill out the form below to register as an expeditor with the Town of Brookhaven on an annual basis.
The annual registration fee is $75 for the business and owner to be registered as an expeditor. If you would like to register an employee other than the owner, the registration fee will be $150 for the owner and the employee.
BUSINESS INFORMATION
Business Name
*
Employer ID
*
Full Business Address (Address, City, State, Zip)
*
Full Mailing Address If Different (Address, City, State, Zip)
Business Type
*
--- Select a Business Type ---
Corporation
Association
Proprietorship
Other Entity or Business Organization
Self Employed
OWNER INFORMATION
Please Enter the Owner / Managing Partner / President / Chief Operating Officer (COO) Contact Information Below
Full Name
*
Full Owner Address (Address, City, State, Zip)
*
Full Mailing Address If Different (Address, City, State, Zip)
Date of Birth
*
Phone Number
*
###-###-####
Email Address
*
A receipt will be emailed to this account.
Name, Address, Phone Number and Title of Person Designated to Accept Legal Notices
*
Have you or any additional employees you are registering ever been convicted of a felony or misdemeanor in the last five (5) years?
*
Yes
No
If yes, state the original charge, the charge upon conviction and the sentence imposed, the date of conviction and the court that imposed it, including the docket, index, indictment or file number in such court
Have you or any additional employees you are registering ever had a judgment against you relating to ligation involving your expediting services or other business dealings?
*
Yes
No
If Yes, state the original causes of action, the result of the litigation or the nature of any settlement, the date of the decision or settlement and the court or jurisdiction that imposed it, including the docket, index or file number in such court.
By typing my name below, I, the undersigned affirm under penalties of perjury that the information contained herein is true. I further affirm that this application is accepted on the condition that the provisions and regulations of the Town of Brookhaven codes and the requirements of the respective Town departments shall be complied with. It is understood that any determination of violation as enumuerated in section 90-7 of the Town of Brookhaven, may result in the immediate revocation of this registration:
*
ADDITIONAL EXPEDITOR EMPLOYEES
Would You Like to Register an Employee Also?
PAYMENT INFORMATION
Payment Type
*
Credit Card
e-Check
Billing Street Address
*
Billing Address Zip Code
*
Credit Card
*
Choose Card Type...
VISA
MAST
DISC
AMER
Name on Credit Card
*
Credit Card Number
*
Credit Card CVV2 Verification Code
*
Expiration
*
Choose month...
01
02
03
04
05
06
07
08
09
10
11
12
Choose Year...
2020
2021
2022
2023
2024
2025
2026
2027
I acknowledge that I will incur a convenience fee of 2.35% of my order total with a minimum fee of $1.50. I acknowledge that if I dispute the charge on my credit/debit card, my application will be null and void and I will be required to reapply with the Town.
*
I acknowledge that if I dispute the charge on my credit/debit card, I will incur a $75.00 Administrative Fee.
*
Subtotal:
Convenience Fee:
Total Cost:
Subtotal
Credit Card Convenience Fee
Total Cost
HID AVS
HID Transaction Type
Prove You Are a Human
*
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