Form 08-4181 - New Alaska Business License Application - 2014 Page 4
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4BUS/TOB
State of Alaska
Department of Commerce, Community, and Economic Development
Division of Corporations, Business and Professional Licensing
BUSINESS LICENSING SECTION
PO Box 110806, Juneau, Alaska 99811-0806
Phone: (907) 465-2550
Fax: (907) 465-2974
OFFICE USE ONLY
Website:
BUS
TOB
CREDIT CARD PAYMENT
Please do not email credit card information. Mail this form to the Division. Completion of this form is not
proof of payment until the Division processes the information contained herein. If any information on this
form is illegible, the form will be rejected. Please print.
Name of Applicant or Licensee:
Corporate or Individual (first, middle, last)
License Number (if applicable):
Type of License:
I wish to make payment by credit card for the following (check all that apply):
Amount
Application fee
License (or renewal) fee
Fine
Other (specify):
Total:
Print Name on Credit Card:
Complete Mailing Address:
Telephone Number:
Email Address (optional):
Credit Card Type (check one):
VISA
MASTERCARD
Signature of Credit Card Holder:
Card Number: ____________________________________ Expiration Date: _____________
The bottom section of this form will be destroyed upon processing of the payment.
08-4181a (Rev. 09/24/14)
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