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2. Vendor 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. Vendor Activity - Select one or more of the following activities associated with your business.*

    1. Food/Beverage Vending Vehicle
    2. Billiards / Pool Tables
    3. Vending Machines
    4. Amusement Devices

    1. Automatic Music Devices
    2. Coin-Operated Amusement
    3. Private Outdoor Pay Telephone
21. Number of Vehicles
22. Food Vending Vehicle Location

    Upload a map showing the location the food vending vehicle will be parked.

24. Which County will the Vehicle(s) Serve?

    1. Cook
    2. DuPage
    3. Both
25. A Food Service Permit must be obtained from DuPage County's Health Department before this vendor license will be issued

    1. I have already obtained my county permit
    2. I have an application pending with the county
    3. I am aware of this requirement and will obtain a food service license from the county
27. A Food Service Inspection must be completed by the Village's contracted Health Inspector before this vendor license will be issued

    1. I have already been inspected and approved
    2. I understand this requirement
29. Food Service Inspection Report

    Upload a copy of your approved food service inspection report

31. Food/Beverage Vending Vehicle Duration

    How long will the vehicle be in use?

    1. Single day, one-time event
    2. Multiple-day, one-time event
    3. Regularly, but not daily
    4. Daily
32. Days of Operation

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday
    5. Thursday
    6. Friday
    7. Saturday
33. Hours of Operation
    Hours of Operation Start Time

    —

    Hours of Operation End Time
35. Billiards - Number of Tables
36. Vending Machine - Type
    -- Select One --CigaretteFoodBoth
37. Number of Cigarette Machines
38. Number of Food Machines
40. Number of Amusement Devices
41. Number of Automatic Music Devices
42. Coin-Operated Devices - Number of Machines
43. Pay Phone - Number of Phones
45. Type of Amusement Devices

    Describe the type of amusement devices

47. Provide a full listing of each machine type with its serial number*

    Example:  Soda Machine 1 - CC123456

49. Any changes to previous number of vehicles or machines?

    1. No change from last year - I am ready to pay.
    2. The number of machines has changed and I need to pay a different amount from last year
    3. I am not sure how many machines were registered last year

    If the number of machines listed has changed, the Inspectional Services Division will need to adjust the fee due before it is paid.  This is not automatic.

    If you have selected that you have changes or do not know the number of machines, please DO NOT continue to make a payment when you are re-directed to the license payment portal after completing this form.  Once the total due for your license is verified, you will be emailed to submit for payment.

51. I certify that the number of machines listed is accurate to the best of my knowledge. I understand that inaccurately reporting machines may result in penalty fees.
    -- Select One --Yes - I have verified the information provided is accurate.
55. Preffered Mailing Address*

    1. Vehicle/Machine Owner Address
    2. Vehicle/Machine Location Address
57. Machine Ownership – Principals, Sole Owners, Shareholders, Partners, etc.

    If you have additional, please attach the listing.

59. Vehicle/Machine Owner*
60. Email Address*
62. Address*
64. City*
65. State*
66. Zip Code*
68. Phone Number*
72. Machine Location

    Building/Property Owner

74. Building/Property Owner*
75. Email Address
77. Address*
79. City*
80. State*
81. Zip Code*
83. Phone Number*
85. Execute*

    1. I agree

    By selecting I agree option below you are giving your electronic signature.
86. No False statements
    Your submission of this form certifies that the information provided is true and correct.
88. Name*

    Information for individual completing this form.

89. Title*
91. Phone Number*
92. Email Address*
Leave This Blank:


94. 1. Receive an email copy of this form.
95. Email address

    This field is not part of the form submission.

96. Submit Submit and Print

* indicates a required field