Permit - Sale of Fireworks

Notice*
No permit will be issued until $50.00 fee is recieved. Please make checks or money orders payable to "County of Henry" and send to: Henry County Fire Marshal's Office 1024 DuPont Road Martinsville, Virginia 24112
Sale Location (Business/Name)
Sale Address Sale Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Sale Contact Person
Seller's Phone Number Seller's Phone Number - ### - ### ####
Supplier Name
Supplier Address Supplier Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Supplier's Phone Number Supplier's Phone Number - ### - ### ####
Supplier's Email
Notes