Nightclub Application
Applicant Information
Step
1
of
8
[DomValidationSum]
Item 1
Corporate Name
*
Contact Name:
*
Applicant is:
Select One
Sole Proprietorship
Corporation
Partnership
Joint Venture
LLC
Other
*
Trading Name:
*
Title/Position:
Select One
Owner
General Manager
CEO
VP
Venue Representative
Business Manager
Other
*
Contact Email:
Mailing Address
Mailing Address 1:
*
Mailing Address 2:
Mailing City:
*
Mailing State:
-
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
*
Mailing Zip:
*
*
Website:
*
Phone:
*
*
Fax:
*
Check here if the applicant has multiple locations
Check here if Location Address is different than the Mailing Address
Location
(if different from Mailing Address)
Location Address 1
*
Location Address 2:
Location City:
*
Location State:
-
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
*
Location Zip:
*
*
Website:
Phone:
*
Fax:
Number of years of management experience the General Manager has at this location or another location that is a similar establishment:
1
2
3
4
5
6
7
8
9
10+
Number of years of management experience the Owner has at this location or another location that is a similar establishment:
1
2
3
4
5
6
7
8
9
10+
Applicant's role(s) for the Location(s):
(check all that apply)
Does the applicant own the building/property?
Select One
Yes
No
*
What percentage of the building does the applicant occupy?
%
List other tenants and describe their operations:
Does the building have more than six apartments?
Select One
Yes
No
*
Description of Location Operations: (check one)
Bar/Tavern
Nightclub
Sports Bar
Live Music Venue
Lounge
Adult Entertainment
*
Broker Information:
Check here if the applicant is using a broker.
Broker Firm Name:
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