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2. 
3. Business License Application

   ^{Updated 03-2023}

5. Applicant Business Information
7. Business Common Name (Doing Business As)*
8. Business Legal Name*
10. Business Description*
11. Business Legal Status*

    1. Limited Liability Company
    2. Corporation

    1. Partnership
    2. Individual
13. Applicant Person Contact Information
15. First & Last Name*
16. Title & Company*
18. Email*
19. Phone Number*
21. Business Location Address
23. Business Address - Line 1*
25. Business Address - Line 2
27. City*
28. State*
29. Zip*
31. Mailing/Billing Address
33. Mailing Address - Line 1*
35. Mailing Address - Line 2
37. City*
38. State*
39. Zip*
41. Business Identification
43. Employer Identification Number (EIN)

    Issued through the IRS
    Format:  _ _- _ _ _ _ _ _ _

44. Illinois Department of Revenue Account ID Number

    Required for all sales on business premises or via addresses in the Village
    Format:  _ _ _ _ - _ _ _ _

46. Property Ownership Information

    ^{(Vehicle ownership for Food Trucks)}

48. Property Ownership Legal Name*
49. Owner Contact First & Last Name*
51. Owner Contact Phone Number*
52. Owner Contact Email
54. Business License Categories
56. Select ONE General Business License Category:*

    1. Home-Based Business
    2. Licensed by State (Exempt)
    3. Laundromat
    4. Peddlers / Food Trucks

    1. Scavengers
    2. Taxicabs
    3. Video Game Terminal Operator (VGT owner or lessor)
    4. General Commercial Establishment (all other businesses)
58. Select ALL Add-On License Categories That Apply:*

    If none apply, select "None of the Above"

    1. Health Inspection (required for all food sales/services)
    2. Gas Station
    3. Car Wash
    4. Cigarette / Tobacco Retailers

    1. Video Gaming Terminal (establishment only)
    2. Vending/Merchandise Machine
    3. Amusement Machine
    4. None of the Above
62. Category-Specific Information Follows

    Only respond to the items below that correspond to your business license category selections above.

64. -- Licensed By State of Illinois (Exempt)
66. State-Issued License Type
67. State Agency Issuer
69. State-Issued License Number
70. State-Issued License Expiration Date
    State-Issued License Expiration Date
72. -- Laundromat
74. Number of machines (washers, dryers, spinners, etc)
76. -- Peddlers / Food Trucks
78. Requested Start Date of License
    Requested Start Date of License
79. Requested End Date of License
    Requested End Date of License
81. -- Taxicabs
83. Number of Vehicles
85. -- Video Game Terminal Operator (VGT owner or lessor)
87. Total Number of VGTs Operated in Richton Park
89. -- General Commercial Establishment
91. Building or Leasehold Square Footage
93. -- Gas Station
95. Number of Gas/Fuel Nozzles
97. -- Car Wash
99. Type

    1. Automatic
    2. Self-Serve / Coin-Operated
100. Number of Car Wash Stalls / Lanes
102. -- Video Gaming Terminal
104. Number of Terminals
106. -- Vending/Merchandise Machine
108. Number of Machines (25 cents or less to operate)
109. Number of Machines (more than 25 cents to operate)
111. -- Amusement Machine
113. Number of Machines
Leave This Blank:


115. 1. Receive an email copy of this form.
116. Email address

     This field is not part of the form submission.

117. Submit

* indicates a required field