Permit - Sale of Fireworks

Notice*
No permit will be issued until $25.00 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 *