Date of Birth* Required

Business Name (Entity or Personal Name)* Required

List legal ownership* 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*

Number of Days* Required Required
The number of days must match the difference between your start and end dates.

Please explain* Required Required

Please upload proof of a current sales tax license from the State of Kansas or proof of exempt status from state sales tax* Required

Please upload a sketch or drawing of the proposed sales site showing the approximate dimensions of the area beingused, the proximity to buildings, parking lots, right-of-ways or other such areas* Required

Please upload the name, address, telephone number and written permission of the owner, or tenant in possession of thelocation described in the application, upon which the applicant intends to offer goods, merchandise, orpersonal property for sale.* Required

the applicant, of lawful age, state that upon signing this application, I understand and agree to the provisions set forth in Chapter 3.95, the Code of the City of Wichita, Kansas, and certify that the information and answers herein contained are complete and true to the best of my knowledge.