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)
Previous City License #
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
Name Title
Home Address
City State ZIP Code
Corporate or LLC
Statutory Agent
Name
SECTION IV. 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
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
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)
Partners, LLC
Members, or
(For Additional Names,
Please Attach List)
Describe Nature of Business:
I certify that the statements made in this application are true and complete to the best of my knowledge. I accept the license / permit authorized and issued in response to
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.
Enter Name if Different from Section I (above) or Enter Care-Of Name
Business Name (Entity followed by DBA)
Location Change
New Owner of Existing Business