APPLICANT INFORMATION

Business Name
	Applicant Full Name
	Primary Phone Number
	Secondary Phone Number
	Email Address

BUSINESS & LICENSE INFORMATION

Please select type of business	Make a selection... Bar/Restaurant Convenience Store Liquor Store Other (explain in comments)
	Please select type of ownership	Make a selection... Corporation Partnership Individual Owner Other (explain in comments)
	When do you need your license?

Enter other comments in the space provided below: