Business License Application
Business License Status
| What would you like to do today: |
---
|
| Is this a: |
---
|
| If you are are applying for a Prescott Valley local license, please select which Series you are applying for |
---
|
Business Name and Physical Location
| Business name or Trade Name |
Family Involvement Center, Inc
|
| Nature of Ownership |
---
|
| Business Street Address (Physical location of the business (cannot be a PO Box) |
8766 E Highway 69, Prescott Valley, AZ 86314 Ste F & G
|
| is the business location: |
---
|
| Mailing Address (Street name and number only) |
5333 N 7th Street A-100
|
| Business Phone Number |
+16024124084
|
| Alternate # (Emergency Phone Number) |
---
|
| Number of Employees |
---
|
| Please choose the most applicable to your business: |
---
|
| Please read carefully through the following list and choose the closest description of your business: |
MENTAL/BEHAVIORAL SERVICES
|
| Business Description (Please describe in detail the nature of the business) |
---
|
| Will your business be selling or serving alcohol? |
---
|
| Start of business date |
---
|
| Locations where the business or applicant has operated during the last 5 years: |
---
|
Applicant Information (Must be completed by the person filling out this application)
| Name (First and Last) |
---
|
| Home Address (No PO Boxes) |
---
|
| Phone number |
---
|
Corporation Information
| State in which the LLC was legally established |
---
|
