Business Information
Business Information
| Business Name |
Your Life Protect LLC
|
| Street Address (Including Unit or Suite, if applicable) |
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|
| City, State, Zip |
Richmond, IL 60071
|
| Mailing Address (If different than business street address above) |
PO Box 487, Richmond IL 60071-0487
|
| Business Phone |
+18158621103
|
| Business Fax |
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|
| 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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|
| Website Address |
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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 |
9:00 am - 6:00 pm
|
| Number of Shifts |
1
|
| Number of Employees |
1
|
| Nature of Business |
Insurance
|
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 |
Terrence Kloss
|
| 1) Phone Number |
+18478153197
|
| 2) Name |
Deborah Kloss
|
| 2) Phone Number |
+18479460608
|
| 3) Name |
Dina Kloss
|
| 3) Phone Number |
+18479516588
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Assign Certificate Number
Certification Number
| Certificate No |
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|
| Fiscal Year |
2025
|
