Business Registration

Business Information

Business Name	Spark'd Dispensary
Business Street Address (Including Unit or Suite, if applicable)	---
Business Phone	+12197160045
Email Address	---
Would you like to sign up for the Village E-Blast for current events and information?	---
Website Address	---

Business Owner Information

Business Owner(s) Name	---
Business Owner(s) Home Address	---
Business Owner(s) Phone Number (Home or Cellphone)	---
Building's Landlord (if Different from Owner)	---
Landlord Address (Incl. City, State, Zip Code)	---
Landlord Phone Number	---

Is This A New Business?

Is This A New Business?

Yes, this a new business.

Other Important Information

Illinois Sales and Use Tax and/or Retailers Occupation Tax	---
Operating Days	Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Operating Hours	10 am to 10 pm
Number of Shifts	2
Number of Employees	25
Nature of Business	Retail

Fueling Stations

Does your business have fueling stations on site?

No

Hoses

Number of gas hoses

0

Police Required Information

Burglar Alarm	Yes
Fire Alarm	Yes
Other Security Measures	---
Hazardous Materials	No

Burglar Alarm

Please Provide Additional Information	---
Monitoring Agency	---
Monitoring Agency Telephone Number	---
Alarm Type	---

Fire Alarm Information

Please Describe Alarm Box Location	---
Monitoring Agency	---
Monitoring Agency Telephone Number	---
Alarm Type	---

Emergency Contacts: Please provide 3 names/phone numbers of key holders who are available 24 hours in case of an emergency.

1) Name	James Sommerfield
1) Phone Number	+12243084906
2) Name	Kurt Berry
2) Phone Number	+16305613248

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

Certification Number

Certificate No

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