Type Full Name :
Sign With Hand
Last Name
Phone #
Name
I, the applicant, hereby certify that the information supplied herein is true and correct. I further certify that the business for which this application is being submitted complies with all applicable statues and regulations and all applicable ordinances. I understand that violation of any applicable statute, regulation, or ordinance may be grounds for revocation of the Business License for which this application is submitted. I further understand that if any information I have provided in this application is willfully false or misleading, I may be subject to denial of this application or revocation of the License for which this application is submitted.
Address
Email
Block
State ID #
Please attach the following documents:
1) Copy of your State License.
2) Certificate of Liability Insurance.
3) Survey and floor plan, or sketch showing the property line.
4) Floor plan of the interior of the building premises where business is to be conducted.
Business Location
Registration Type
Address
Address 2
Pool Tables?
City, State, ZIP
Ownership Type
Address
Phone #
Name
Business Information
Name
Lot
Emergency Contact Information
Building Owner Information
Amount Due
Relationship to Business Owner
State
Federal ID #
Phone #
Additional Business Amenities Information
Occupancy Load
Fees
Last Name
Is this a non-profit organization?
Phone #
Business Category
First Name
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Phone #
Address
Certification
Peddlers & Solicitors?
Attachments
Applicant Signature
Business Owner Information
# of Employees
Business Description (Describe the Nature of the Business, including types of products sold, services provided, or activities to be conducted.)
First Name
City
Alarm Company Information
Video Game Machines?
Days and Hours of Operation
Amount
Email
Square Feet
Website URL
Email
ZIP
{[PNAME]}
Application
Search for the business address and select it from the drop-down:
Soft Drink Machines?