Wichita Business License Application

Applicant Information

Name (First Middle Last)*
Address*
City* State* Zip*
Primary Phone* Email*

Business Information (location for which license is desired)

Business Name (Entity or Personal Name) *

DBA Name (If applicable) Required

Attention
Business Physical Address
(Please include unit/suite number. PO Box's will not be accepted for physical address) *
City* State* Zip* Business Phone*

Property Owner Information

Property Owner*
Property Owner Address*
City* State* Zip*

Mailing Address (Official address where correspondence may be sent, and complaints served.)

Mailing Address same as Business Address

Mailing Address *

Mailing City* Mailing State* Mailing Zip*

Owner Information

Business Entity Ownership Name*
Business Entity Ownership Address*
City* State* Zip*

List legal ownership*

select

Federal Tax ID Number Driver's License Number

State License Information

KS Business Entity ID #*

License Type* License Number* Issue Date*

Open the calendar popup.

Please upload copy of Valid Kansas Tobacco License*

Tobacco Information

Hours/Days of Operation*

Have you ever had any license denied, revoked, or suspended by the City of Wichita or the State of Kansas or any governmental entity* Yes No

Acknowledgements

I am familiar with the conditions imposed by the terms of Chapter 7.60 of the Municipal Code I consent and agree that any City employee designated to enforce this code may at any time, enter and inspect any part of the premises I will notify City Licensing within 10 days of any change to the offical mailing address. I agree to comply with all the laws, rules, and regulations of the City of Wichita and the State of Kansas.
Please check all of the above

Certification/Signature

By submitting this application, I ,

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.

Executed the .

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