Effective Date
/
Month
/
Day
Year
Date
Business Name
DBA
Address
Suite
City
State
Zip
Contact Person
Phone #
E-Mail
example@example.com
EIN#
Total Annual Sales
Food Sales
Liquor Sales
(These 2 numbers should equal total)
Payroll
Number of Employees
Do you offer delivery? (not 3rd Party)
Yes
No
If Yes, What Percentage
Square Footage of your space
Remodeled year
Do you have Live Music?
Yes
No
Do you have a dance floor?
Yes
No
Do you have a cover charge?
Yes
No
Monitored Burglar Alarm?
Yes
No
Building Sprinkled
Yes
No
Building Limits - If you own the building
BPP - Business Personal Property
Tenants and Improvements
Description of operations:
Preview PDF
Submit
Should be Empty: