Business Name (Entity or Personal 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

Other Names Used 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*

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

Process Agent Spousal Information

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
Date of Birth Required Last 4 of SSN Required Enter 4 digits Birthplace Required Required Marital Status Required Driver's License Number Required Other Names Used Required Maiden Name Required

Please explain* Required Required

Please upload a copy of a certificate of general liability insurance in the amount of $250,000.00 per short-term rental unit. Liability insurance provided by a third party, such as an online booking platform, is acceptable proof of the required liability insurance*

Please upload two forms of proof of owner occupation. To be an owner-occupied short term rental, the owner must reside on the premises AND be present during the time that the dwelling unit is rented as a Short Term Rental. Identifying numbers such as Social Security Numbers, Driver’s License Numbers, and Bank Account number must be redacted on the copies provided to the City. Acceptable forms of proof include:

• (1) A Kansas Driver’s License;
• (2) Other valid State of Kansas Identification Card;
• (3) Sedgwick County Voter Registration Card;
• (4) Current employer verification of residential address from the employer on company letterhead;
• (5) Current automobile, life or health insurance policy;
• (6) Paycheck/check stub;
• (7) IRS W-2 Form;
• (8) A bank statement;
• (9) Other documentation showing the owner’s residential address.

* Required

Please upload a scaled floor plan showing the layout and square footage of the Short-Term Rental Unit(s). Such floor plan, at a minimum, shall include a designation and location of bedrooms, bathrooms, and kitchens, the dimensions of such rooms and the means of ingress and egress within each room and the dwelling unit.* Required

Required

Required

I hereby certify that I have read and am familiar with Chapter 3.40 of the Code of the City of Wichita and with the requirements thereof as they pertain to my license. Further, I understand and certify that I, the owner, responsible party, or any employee thereof will not, in renting or leasing a Short-Term Rental Unit, discriminate against any person or persons on the basis of race, color, sex, religion, national origin, ancestry, disability, sexual orientation, sexual identity, gender identity or age .