Business License Application
Business License Status
| What would you like to do today: |
---
|
| Is this a: |
---
|
| If you are are applying for or renewing a PV liquor License, please select which Series you are applying for |
---
|
Business Name and Physical Location
| Business name or Trade Name |
Medina Creative Solutions
|
| Nature of Ownership |
---
|
| is the business location: |
---
|
| Mailing Address (Street name and number only) |
3131 N. Robert Road
|
| Mailing Address City, State, & Zip Code |
Ste. A, Prescott Valley AZ 86314
|
| Business Phone Number |
+19282737450
|
| Alternate # (Emergency Phone Number) |
---
|
| Number of Employees |
---
|
| Please choose the most applicable to your business: |
---
|
| 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: |
---
|
Individual/ Sole Proprietor Owner Information (Eligibility Form)
| Name (First and Last) |
---
|
| Title |
---
|
| Home street address (cannot be a PO Box) |
---
|
| Social Security Number (Last four (4) only) |
---
|
| Phone Number |
---
|
| *Check the boxes next to the document you are presenting to the Town, indicating lawful presence |
---
|
Applicant Information (Must be completed by the person filling out this application)
| Name (First and Last) |
---
|
| Home Address (No PO Boxes) |
---
|
| Phone number |
---
|
