Business License Application
Business License Status
| What would you like to do today: |
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| Is this a: |
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| If you are are applying for a Prescott Valley local license, please select which Series you are applying for |
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Business Name and Physical Location
| Business name or Trade Name |
CC Services, Inc. (dba: COUNTRY Financial)
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| Nature of Ownership |
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| Business Street Address (Physical location of the business (cannot be a PO Box) |
8521 E Florentine Rd, Ste C
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| is the business location: |
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| Mailing Address (Street name and number only) |
1711 General Electric Rd
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| Mailing Address City, State, & Zip Code |
Bloomington, Illinois, 61704
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| Business Phone Number |
+19283626010
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| Alternate # (Emergency Phone Number) |
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| Number of Employees |
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| Please choose the most applicable to your business: |
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| Please read carefully through the following list and choose the closest description of your business: |
INSURANCE
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| Business Description (Please describe in detail the nature of the business) |
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| Will your business be selling or serving alcohol? |
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| Start of business date |
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| Locations where the business or applicant has operated during the last 5 years: |
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Applicant Information (Must be completed by the person filling out this application)
| Name (First and Last) |
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Corporation Information
| Name of the Business (if owned by another entity) |
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