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Davenport Broker Business License Application

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Davenport Broker Business License Application Powered By Docstoc
					                                                                                                                                     City of Davenport
                                                                                                                                     Business Licensing
                                                                                                                                      226 West 4th Street
                                                                                                                                  Davenport, Iowa 52801
                                                                                                                                  Phone: (563) 326-7715
                                                                                                                                    Fax: (563) 326-7722
                                                      Business License Application
                                           Please print in dark ink and mail to Business Licensing Service

Business Name:
                                   Enter the name you will be doing business as. You must operate and advertise in the exact name listed.


Parent Company Name:
 (If Corporate Owned)

Business Address:
(Cannot be a P.O. Box)      Street #                  Street name                        Unit #                City                         State   Zip

Billing Address
 (Can be a P.O. Box)        Street #                  Street name                        Unit #                City                         State   Zip

Mailing Address
     (If different)         Street #                  Street name                        Unit #                City                         State   Zip

Phone:      (           )              -                    Business Start Date:

Ownership (Check One Only)
                      Sole Proprietor              Partnership                  Corporation                     LLC

                      LLP                          LP                           Other:

E-mail:

Website:


                                                        OWNER'S OR PRINCIPAL'S NAME(S)
  Name                                                                           Name

  Home Address                                                                   Home Address

  City                                                Zip                        City                                                Zip

  Telephone #                                         Title                      Telephone #                                         Title


                                                   REAL ESTATE OWNER INFORMATION
  Name                                                                       City

  Address                                                                    State                                                 Zip
                                                           TYPE OF BUSINESS

Please Check One:
         Wholesale             Retail        Other                                     Iowa Sales Tax ID No.

Fully Describe Business Operation:                                                     Exact Size of Retail/Wholesale Sales Area:

                                                                                       Exact Size of Storage/Manufacturing Area:


                                                                LICENSES
                                                             Check all that apply

         Retail, Seasonal               Retail, No Floor Space                  Retail, < 4,000 sq. ft.              Retail, > 4,000 sq. ft.
         Wholesale Distributor          Dry Cleaners                            Auctioneer Sales Room                Auctioneer, All Year
         Employment Office              Broker                                  Private Club                         Tent Permit, Fire Regulation
         Miniature Golf                 Vehicle Rentals                         Public Garages                       Tree Trimmer
         Dancehall in Nightclub         Dancehall, Principal Business           Mobile Home/Travel Trailer Park
         Pool Tables #                  Game Machines #                         Jukeboxes #
         Theatre - seats                Bowling Alley - lanes

                                                           OTHER LICENSES

         Cigarette                      Entertainment                           Health                               Liquor

                                                 PREVIOUS LICENSING INFORMATION
Have you ever applied for this type of license before?                  If yes, provide the following information:
    a. Owner's name as it appeared on the license:


    b. Name of the business:

    c. Location of the business:

Has your license ever been revoked?               If so, when?


 Signature of Applicant                                                                     Date

				
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posted:9/16/2013
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