{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
https://mapleshade.com/
ZIP
Business Location Information
Registration Type
Mailing Address (If different)
Lot
Block
City
Phsyical Address
{[PNAME]} Application
Search for the business address and select it from the drop-down:
State
  • Contacts
  • Business Information
  • Attachments & Disclosures
  • Fees & Certification
Full Name
State
Email
Email
Address
Full Name
Full Name
ZIP
Ownership Type
Cell Phone #
City
Property Owner Information
Address
Home Phone #
ZIP
Cell Phone #
State
City
State
Phone #
Business Owner Information
City
Applicant Information
Home Phone #
Is the property owned by the applicant?
Email
Business owner same as...
ZIP
Address
Phone #
Total # of Coin Operated Devices:
Hours of Operation
If "Yes", please indicate the types and quantities of each type of device:
Is there a grease trap on the premises?
Business Name
Business Information
Describe products sold:
Type of Business: (Describe)
Alternate Email
Are there any coin operated machines on the premises?
Fax #
Email
Date Opened
Does the owner/operator presently possess any state or local business or professional license?
Licensing Disclosure
Please attach the following documents:
1) Photo copy of your driver's license.
2) Certificate of Liability Insurance.
3) Grease Trap Certification. (If applicable)
Criminal History Disclosure
If "Yes", please explain:
Have applicant, partners, or officers been convicted of misdemeanors or crimes?
If "Yes", please explain:
Attachments
Type Full Name :
Sign With Hand
I certify that all information & statements herein are true and correct to the best of my knowledge.
Description Fee
Initial Application $75
Grease Trap Fee (If applicable) $50
Amount Due
Fees
Certification
Applicant Signature