City of Chandler
Business Registration
Tax & License Division
Telephone: 480-782-2299
Location address: 175 S. Arizona Ave, Suite A, Chandler, AZ 85225
Mailing Address: MS 701, PO Box 4008, Chandler, AZ 85244-4008
E-mail: licensing@chandleraz.gov Fax: 480-782-2343
Check one:
$15 Location Change Fee
Name of Former Owner (if applicable)
OR
Current City License #
Previous City License #
Date of Change
SECTION I. BUSINESS INFORMATION
Business Phone (Including Area Code)
Start Date In Chandler
E-mail address State Tax License # Federal ID #
(REQUIRED)
SECTION II. MAILING ADDRESS & PHONE NUMBER
Phone (Including Area Code)
SECTION III. BUSINESS OWNERSHIP & RECORD LOCATION
Ownership: Individual LLC Corp. - State Inc.______ Gen. Partnership Ltd. Partnership Other _____________
Name Title
Home Address
City State ZIP Code
Phone
Name Title
Home Address
City State ZIP Code
Phone
Corporate or LLC
Statutory Agent
Name
Phone
SECTION IV. BUSINESS TYPE
Business Type
Retail Sales Restaurant/Bar Amusement Construction Contracting Service Based Wholesaler
Manufacturer Commercial Rental Hotel/Motel Other__________________________________________
SECTION V. BUSINESS PREMISES STATUS
Do you own your business location? Yes No If yes, is this your residence? Yes No
If no, complete Landlord/Property Manager information below
Landlord/Property Manager Name
Addres
s
Phone
Do you rent a portion of your location to another business? Yes No
Print Name Signature Title Date
FEES ARE NOT REFUNDABLE LATE FEES MAY APPLY FOR APPLICATIONS RECEIVED DELINQUENT
Annual Fee:
Late Fee:
Rev. Sep-18
Staff Use Only Below This Line
NAICS ST CODE LAWA Required Entered By Paid Balance Owed Approved By Date
Y / N
Jan - Mar $45.00 Apr - Jun $33.75 Jul - Sep $22.50 Oct - Dec $11.25
Jan - Mar $22.50 Apr - Jun $16.88 Jul - Sep $11.25 Oct - Dec $5.63
Business Location Address
Number of Employees (at this location)
Owners,
Partners, LLC
Members, or
Officers
(For Additional Names,
Please Attach List)
Describe Nature of Business:
this application with the condition that the issuance of this license / permit shall not be construed as permission to operate in violation of any law or regulation. Incomplete
forms may not be processed.
Mailing Address
City, State, ZIP Code
Enter Name if Different from Section I (above) or Enter Care-Of Name
Business Name (Entity followed by DBA)
City, State, ZIP Code
Check any
that apply:
DBA Change
Location Change
New Business
New Owner of Existing Business
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