Phone #
ZIP
City
Business Details
Registration Type
Address
Business has a minimum of 300 sqft?
State
Business Name (include trade name)
ZIP
Who owns the games?
City
Principal Office
Federal ID #
State
Address
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Sq. Ft.
{[PNAME]}
# of Video Game Machine(s)
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  • Instructions
  • Contacts
  • Details
  • Attachments
  • Certification

Instructions

  • A separate application is required for each location.
  • Property Taxes of owner must be paid prior to receiving license (Ordinance No. 4803).
  • Over 6 machines in any one location constitutes an '' Amusement Complex'' and shall be limited to BC Zones only.
  • Floor Plan must be attached to application. Square footage excludes storage area, offices, Kitchens, Counter space, walkways, alleys, drives, parking facilities or such areas to which the public has no access.
  • A four-foot aisle shall be maintained between the exterior side of the machines and an eight-foot aisle between rows of machines.
  • No machine shall be placed within four feet of the entrance way or exit of licensed premises.
Last Name
Name
ZIP
Address
Email
Email
Address
Total Ownership %
Last Name
Last name
SSN #
Date of Birth
If Other
Address
First name
City
Ownership Type
Mailing City, State, ZIP
Last Name
Phone #
ZIP
First Name
Is the Distributor same as the Owner?
Emergency Contact Details
Building Owner Details
City
Phone #
State
Address
Email
Phone #
First Name
Last Name
Agent Details
First Name
Additional Owner Details
Is the Owner same as the manager?
Distributor Details
Phone #
Date of Birth
SSN #
Business Owner Details
SSN #
Date of Birth
First Name
City
Manager Details
Phone #
State
State
Email
ZIP
Games Details
Disclaimer: Floor Plan must be attached in order to process your application.
Attachments
Type Full Name :
Sign With Hand
I, the Applicant, do solemnly swear that all the information here and attached hereto is true and correct.
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Amount Due
Fee Schedule
Certification
Applicant Signature