Business Information
Business Information
| Business Name |
Stateline Corp
|
| Business Street Address (Including Unit or Suite, if applicable) |
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|
| Business Phone |
+18473958393
|
| Email Address |
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|
| Would you like to sign up for the Village E-Blast for current events and information? |
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|
Business Owner Information
| Business Owner(s) Name |
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|
| Business Owner(s) Home Address |
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|
| Business Owner(s) Phone Number (Home or Cellphone) |
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|
Is This A New Business?
| Is This A New Business? |
No, my business was registered under the same name prior to May 1st of this year.
|
Other Important Information
| Illinois Sales and Use Tax and/or Retailers Occupation Tax |
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|
| Operating Days |
Monday, Tuesday, Wednesday, Thursday, Friday
|
| Operating Hours |
8:00am-4:00pm
|
| Number of Shifts |
1
|
| Number of Employees |
1
|
| Nature of Business |
Office
|
Fueling Stations
| Does your business have fueling stations on site? |
No
|
Hoses
Police Required Information
| Burglar Alarm |
No
|
| Fire Alarm |
No
|
| Hazardous Materials |
No
|
Emergency Contacts: Please provide 3 names/phone numbers of key holders who are available 24 hours in case of an emergency.
| 1) Name |
Reagan Keyzer
|
| 1) Phone Number |
+12622064226
|
| 2) Name |
Harry Bond
|
| 2) Phone Number |
+18475145030
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Initial Review
Late Fees
| Was this submitted after May 22? |
No
|
Prorated Fees
| Was this submitted between August 1 - October 31? |
No
|
| Was this submitted between November 1 - January 31? |
No
|
| Was this submitted After February 1? |
No
|
Assign Certificate Number
Certification Number
