Location Name * Required

Mailing City* Required Mailing State* Enter a Valid US State Required Mailing Zip* Minimum 5 characters required. Required

Name (First Middle Last)* Required
Address* PO Boxes are not allowed Required
City* Required State* Enter a Valid US State Required Zip* Minimum 5 characters required. Required
Primary Phone* Required Minimum 10 digit phone required. Primary owner’s phone cannot be the same as the additional contact’s phone. Minimum 10 digit phone required. Required Email* Please enter a valid e-mail address. Required

Contact Above's Spouse

Name Required
Address Required
City Required State Enter a Valid US State Required Zip Minimum 5 characters required. Required
Primary Phone Required Minimum 10 digit phone required. Minimum 10 digit phone required. Required Email Please enter a valid e-mail address. Required
Date of Birth Required Last 4 of SSN Required Enter 4 digits Birthplace Required Ownership % Required Marital Status Required Required Driver's License Number Required Other Names Used Required Maiden Name Required

Owner2

Name Required
Address Required
City Required State Enter a Valid US State Required Zip Minimum 5 characters required. Required
Primary Phone Required Minimum 10 digit phone required. Minimum 10 digit phone required. Required Email Please enter a valid e-mail address. Required

Contact Above's Spouse

Name Required
Address Required
City Required State Enter a Valid US State Required Zip Minimum 5 characters required. Required
Primary Phone Required Minimum 10 digit phone required. Minimum 10 digit phone required. Required Email Please enter a valid e-mail address. Required

Owner 3

Name Required
Address Required
City Required State Enter a Valid US State Required Zip Minimum 5 characters required. Required
Primary Phone Required Minimum 10 digit phone required. Primary owner’s phone cannot be the same as the additional contact’s phone. Minimum 10 digit phone required. Required Email Please enter a valid e-mail address. Required

Contact Above's Spouse

Name Required
Address Required
City Required State Enter a Valid US State Required Zip Minimum 5 characters required. Required
Primary Phone Required Minimum 10 digit phone required. Minimum 10 digit phone required. Required Email Please enter a valid e-mail address. Required

Owner 4

Name Required
Address Required
City Required State Enter a Valid US State Required Zip Minimum 5 characters required. Required
Primary Phone Required Minimum 10 digit phone required. Minimum 10 digit phone required. Required Email Please enter a valid e-mail address. Required

Contact Above's Spouse

Name Required
Address Required
City Required State Enter a Valid US State Required Zip Minimum 5 characters required. Required
Primary Phone Required Minimum 10 digit phone required. Minimum 10 digit phone required. Required Email Please enter a valid e-mail address. Required

Please upload a list of any additional owners*

KS Business Entity ID #* Required

License Type* Required License Number* Required Issue Date* Required

Federal Tax ID Number* Required Required

I have had a license denied, revoked, or suspended by the City of Wichita or the State of Kansas or any other governmental entity. * Yes No Required Required

Please explain* Required

Please upload a copy of the Certificate of General Liability Insurance certificate that shows a minimum of $1,000,000 coverage for incidents involving guests of the lodging establishment.* Required

Acknowledgements

Please check all of the lodging acknowledgements.

declare under penalty of perjury, under the laws of the State of Kansas, that the above application is true and correct to the best of my knowledge. I certify that I will operate my business in accordance with all applicable federal, state and local laws and regulations. I further understand that any false statements made above are grounds for denial or revocation of the business license.