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Business License Renewal Application Form

2. Business Information *

   Provide local business & corporate information

   1. Incorporated- Secretary of State
   2. Sole Proprietor- County
3. Corporate Name/ Sole Propietor*
4. Assumed Business Name/DBA*
6. Business License Renewal No.*
   This number is provided to you in your renewal form.
7. Business License No.*
   This number is provided to you in your renewal form.
8. IBT No./Retailer's Occupational Tax No.
9. FEIN Number
11. Preffered Mailing Address*

    1. Business Address
    2. Corporate Address
13. Business Address*
14. Phone Number *
16. City*
17. State*
18. Zip Code*
20. Corporate Address
21. Phone Number
23. City
24. State
25. Zip Code
27. Ownership – Principals, Sole Owners, Shareholders, Partners, etc.
    If you have additional, please attach the listing.
29. 1. Business Owner*
30. Email Address*
32. Address*
34. City*
35. State*
36. Zip Code*
38. Phone Number*
39. Cell Number*
41. 2. Business Owner
42. Email Address
44. Address
46. City
47. State
48. Zip Code
50. Phone Number
51. Cell Number
53. Key Holders/Emergency Contacts
    A minimum of (2) two contacts are required. Do NOT provide ownership info. as listed above.
55. 1. Key Holder*
    Cannot be owner information. Please provide alternative contacts.
56. Title*
57. Cell Phone Number*
59. 2. Key Holder*
    Cannot be owner information. Please provide alternative contacts.
60. Title*
61. Cell Phone Number*
63. Property Ownership
    Building Owner
65. Building Owner*
66. Email Address
68. Address
70. City
71. State
72. Zip Code
74. Phone Number*
75. Cell Number
77. Execute*

    1. I agree

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


86. 1. Receive an email copy of this form.
87. Email address

    This field is not part of the form submission.

88. Submit

* indicates a required field