Massage Establishment Business Application

Print
Press Enter to show all options, press Tab go to next option
Please correct the field(s) marked in red below:

1

Applicant or Agent's Name (All Owners Must Also Complete individual application)

 *
Applicant or Agent's Name (All Owners Must Also Complete individual application)
2
Corporation, L.L.C. or Partnership Name
3

Doing Business As: 

4
Business Address (local)
 *
Business Address (local)
5
Mailing Address
 *
Mailing Address
6
Email
7
Ownership Type:
 *
Ownership Type:
8
Has This Business Had Any Change in Name, Location, or Ownership?
 *
Has This Business Had Any Change in Name, Location, or Ownership?
9
Type of Business Activity Engaged In
10
Types of Products Sold (If applicable)
11
Has this Business been licensed in another City or State?
 *
Has this Business been licensed in another City or State?
12
Has this business ever had its license or permit denied, revoked, suspended or fined in this or any other State?
 *
Has this business ever had its license or permit denied, revoked, suspended or fined in this or any other State?