Type Full Name :
Sign With Hand
Email *
If "Yes", provide details of the denial, revocation or suspension
State *
Address *
Block
Applicant Signature *
Has any individual, partner, officer or stockholder ever been convicted of a crime? *
If "Yes", provide details of the ownership or beneficial interest below
By signing below I certify that I, the applicant, confirm that the information provided in this application is true and accurate and that I have/will provide all of the information requested in this application, without which this application will not be deemed as valid and as such will forfeit any application fees paid.
Provide details of all businesses the applicant has either been engaged in or employed by for five (5) years preceding the application date of this application.
Certification
Last Name *
Business Name *
If "Yes", provide details of the conviction and charges
Business/Employment History
Business Information
Required Documents
Provide details of the Manager responsible for the day to day operation of the automotive repair facility
Type *
State *
Application for
Automotive Repair Facilities
License Fee
Does the applicant have an ownership or beneficial interest in any other automotive repair facilities? *
ZIP *
123 Main Ave, Your Town USA 90210
(555) 973-2212
www.yourtown.us
Documents
Phone *
Address *
If the applicant is a partnership or corporation, provide details of all stockholders and/or partners that have own a percentage of the business
Partner/Officers Information (if applicable)
Applicant Information
City *
Address *
Fax *
First Name *
Has the applicant or manager ever been denied a license, or had a previous license revoked or suspended? *
Amount Due
The following documents MUST be provided with all applications:

Applications for New Automotive Repair Facilities

  1. A valid Certificate of Occupancy for the facility
  2. A valid Business Registration
  3. New Jersey Sales Tax Certificate
  4. New Jersey Employer Identification Number
  5. Proof of Age for the Applicant (E.g. Birth Certificate or valid Driver's License)
  6. A list of all employees that will be employed by the business
  7. Two (2) passport size (2in x 2in) photographs of the Applicant and the Manager
Applications for Renewal
  1. Two (2) passport size (2in x 2in) photographs of the Applicant and the Manager
  2. A valid Certificate of Occupancy for the facility
  3. A list of all employees that will are employed by the business
Manager Information
Last Name *
Your
Town
Lot
Mandatory, non-refundable application fee of $25.00 for every application due for new and renewal applications
License fee $100.00 if issued
City *
First Name *
ZIP *
Email *
Phone *
Phone *
Applicant Background Information
Is this Application for a New Business or Renewal of Existing Business?