Business License Application Form

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Business License Application
12350 W 87 Street Pky
Phone 913-477-7500
P.O. Box 14888
Fax 913-477-7730
Lenexa, KS 66285-4888
Check if applicable:
This is a change in
business name
business ownership
physical business address
/
/
Lenexa Business Start Date
rev. 2/25/15
____________________________________________________
___________________________________________________
Common Name of Business (DBA)
Legal Name of Business (if different than DBA)
____________________________________________________
Type of Business (Contractor, Physician, Retail Sales)
PLEASE NOTIFY US IF YOU DISCONTINUE
YOUR BUSINESS – THANK YOU!
Physical Business Address:
_______________________________
_________________ ________________________ _________ ___________
Street # (or range of #s) and Name
Suite, Apt, Pillar, etc.
City
State
Zip
(
)_________________
(
)_____________________
(
)__________________
Business Address Phone #
Cell #
Fax #
Mailing Address: (if different from Physical Address)
Name for Mailing Address:
DBA
Legal Name
Other _____________________________________________
________________________________
_________________ ________________________ _________ ___________
Street # (or range of #s) and Name
Suite, Apt, Pillar, etc.
City
State
Zip
(
)_________________
(
)_____________________
(
)__________________
Mailing Address Phone #
Cell #
Fax #
Contacts:
Primary Contact (Owner/Corp. Agent/Applicant)
__________________________
_________________________________
Name
Email Address
_____________________________
__________________ _______ ________ (
)_________ (
)_________
Home Address – Street # and Name
City
State
Zip
Phone #
Cell Phone #
___________________
______________________________
___________
Date of Birth
Driver’s License #
State Issued
Secondary Contact: _____________________________________ _______________________________________________
Name
Email Address
_____________________________________________
(
)______________
(
)________________
Type of Contact
Phone #
Cell Phone #
Please complete this section if your business is physically located in Lenexa.
Is business located in a Lenexa residence?
N
Y - please complete a Home Business Zoning Permit application
Are you sub-leasing this space?
N
Y - please complete information in #3 on Certificate of Occupancy
Do you have a fire/intrusion alarm?
N
Y - complete an Alarm User Registration at
Total Square Footage __________________
Kansas State Sales Tax Number ________________________
ENTER INFORMATION BELOW FOR THIS BUSINESS LOCATION, IF APPLICABLE:
Auto Dealers, inside: # sq. ft. _________
Personal Service (Hair/Nails): # operators ______
Auto Dealers, outside: # sq. ft. _________
Professionals: # licensed professionals ________
Banks: # detached facilities __________
Refuse Haulers, Commercial: # trucks ________

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