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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.

    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.

    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

    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.

    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:


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

    This field is not part of the form submission.

87. Submit

* indicates a required field