Application For Business License - City Of Chicago Department Of Revenue Page 2
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6Corporate Name ___________________________________ Business Name ______________________________
Corporate Address ________________________________
Business Address _____________________________
Unit #
_________________________________________________
____________________________________________
City
State
Zip
City
State
Zip
Corporate Phone __________________________________
Business Phone _______________________________
Contact Person: __________________________________
Please indicate where you would like your mail sent to:
Mailing Name
________________________________________________
Mailing Address ________________________________________________
______________________________________________________________
City
State
Zip
OWNER/OFFICER INFORMATION
Sole Proprietor _____________________________________ Social Security Number ________________________
Home Address _____________________________________ Date of Birth _________________________________
__________________________________________________ Home Telephone Number ______________________
City
State
Zip
__________________________________________________________________________________________
Partnership 1/Proprietor 2 ____________________________ Social Security Number ________________________
Home Address _____________________________________ Date of Birth _________________________________
__________________________________________________ Home Telephone Number _______________________
City
State
Zip
Partnership 2 ______________________________________ Social Security Number ________________________
Home Address _____________________________________ Date of Birth _________________________________
__________________________________________________ Home Telephone Number _______________________
City
State
Zip
________________________________________________________________________________________________
President _________________________________________ Social Security Number ________________________
Home Address _____________________________________ Date of Birth _________________________________
__________________________________________________ Home Telephone Number _______________________
City
State
Zip
Vice President _____________________________________ Social Security Number ________________________
Home Address _____________________________________ Date of Birth _________________________________
__________________________________________________ Home Telephone Number _______________________
City
State
Zip
Secretary _________________________________________ Social Security Number ________________________
Home Address _____________________________________ Date of Birth _________________________________
__________________________________________________ Home Telephone Number _______________________
City
State
Zip
Page 2
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Parent category: Financial