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2. Dealer License Application Form - Renewal
4. Instructions

   1. Complete the Renewal Application Form. 

   2. Submit electronically. You may print a copy for your records.

   3. You will be redirected automatically to the Licensing Payment Portal.

   4. Enter your License Type, License Number, Renewal Number exactly as it appears on your renewal notice.

   5. Submit electronic payment.

8. Business Information *

   Provide local business & corporate information

   1. Incorporated- Secretary of State
   2. Sole Proprietor- County
9. Corporate Name/ Sole Propietor*
10. Assumed Business Name/DBA*
12. Vendor License Renewal No.*

    This number is provided to you in your renewal form.

13. Vendor License No.*

    This number is provided to you in your renewal form.

    
    

14. IBT No./Retailer's Occupational Tax No. *
15. FEIN Number*
19. Preffered Mailing Address*

    1. Business Address
    2. Corporate Address
21. Business Address*
22. Phone Number *
24. City*
25. State*
26. Zip Code*
28. Corporate Address
29. Phone Number
31. City
32. State
33. Zip Code
35. Ownership – Principals, Sole Owners, Shareholders, Partners, etc.
36. Addtional Information
    If you have additional owners, please attach a listing.
38. 1. Business Owner*
39. Email Address*
41. Address*
43. City*
44. State*
45. Zip Code*
47. Phone Number*
49. 2. Business Owner
50. Email Address
52. Address
54. City
55. State
56. Zip Code
58. Phone Number
60. Employees

    All new employees are required to submit to a history and background check and be approved by the Inspectional Services Division. Please call 630-823-5860 to make an appointment for fingerprinting.

61. Additional Information
    If you have additional employees, please attach a listing.
63. 1. Name*
64. Title*
65. Age*
66. Start Date*
68. 2. Name*
69. Title*
70. Age*
71. Start Date*
73. 3. Name
74. Title
75. Age
76. Start Date
78. 4. Name
79. Title
80. Age
81. Start Date
83. Property Ownership
    Building Owner
85. Building Owner*
86. Email Address
88. Address*
90. City*
91. State*
92. Zip Code*
94. Phone Number*
96. Execute*

    1. I agree

    By selecting I agree option below you are giving your electronic signature.
97. No False statements
    Your submission of this form certifies that the information provided is true and correct.
99. First Name*
    Information for individual completing this form.
100. Title*
102. Phone Number*
103. Email Address*
Leave This Blank:


105. 1. Receive an email copy of this form.
106. Email address

     This field is not part of the form submission.

107. Submit Submit and Print

* indicates a required field