
1. OWNER INFORMATION
- First and Lastname: Jayden Berkowitz
Phone Number (Optional): 564-4426
Email (Optional): [email protected]
2. BUSINESS INFORMATION
- Name of Business: Berkowitz Gaz
Link to Registration: viewtopic.php?p=1090350#p1090350
Business Address: 98 Panorama Dr
Subsidiary Names (if applicable): N/A
Business Registration Type:
Mark an X in the appropriate checkbox.
[X] Stand-Alone
[ ] Subsidiary [Parent Company Name]
[ ] Parent
3. LICENSES APPLIED FOR
- Please note as a Parent Company, one license can be used for up to 2 Subsidiaries, but you can subscribe to multiple of the same type of license. If this applies to you, please mention how many subsidiaries need the license.
Please list all licenses you wish to apply for from the list HERE:
((DUPLICATE AS NEEDED))
- LICENSE #1
License Name: GRBL:04 - Fuel Retailer
Vending Machine License (If applicable)
- Address of Vending Machine: 98 Panorama Dr
Photo of Vending Machine: *ATTACHMENT* Next to the fuel pump on the right side
- LICENSE #1
4. AGREEMENT
- By submitting this request, you hereby agree that all information provided is truthful. You agree that you have read & understood all requirements, regulations and penalties related to the license(s) you are applying for. If your request is approved, you agree to a continuous effort to adhere to laws and regulations laid out by the San Andreas State Government. You also agree to submit any future changes to your business to the Business Licensing Bureau. You also agree to a full legal background check of your person.
Owner's Signature: Jayden Berkowitz
Date: 23/NOV/2025




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