* indicates a required field

2. Dealer License Application Form - New
4. Instructions

   1. Complete the Renewal Application Form. 

   2. Submit electronically. You may print a copy for your records.

   3. Village staff will review your application and contact you when the review is complete.

   4. Submit electronic payment if application is approved. 

8. Business Information *

   Provide local business & corporate information

   1. Incorporated- Secretary of State
   2. Sole Proprietor- County
9. Corporate Name/ Sole Propietor*
10. Assumed Business Name/DBA*
12. IBT No./Retailer's Occupational Tax No. *
13. FEIN Number*
17. Preferred Mailing Address*

    1. Business Address
    2. Corporate Address
19. Business Address*
20. Phone Number *
22. City*
23. State*
24. Zip Code*
26. Corporate Address
27. Phone Number
29. City
30. State
31. Zip Code
33. Ownership – Principals, Sole Owners, Shareholders, Partners, etc.
34. Addtional Information
    If you have additional owners, please attach a listing.
36. 1. Business Owner*
37. Email Address*
39. Address*
41. City*
42. State*
43. Zip Code*
45. Phone Number*
47. 2. Business Owner
48. Email Address
50. Address*
52. City
53. State
54. Zip Code
56. Phone Number
58. Employees

    All new employees are required to submit to a history and background check and be approved by the Inspectional Services Division. Please call 630-823-5860 to make an appointment for fingerprinting.

59. Additional Information
    If you have additional employees, please attach a listing.
61. 1. Name*
62. Title*
63. Home Address*
65. 2. Name*
66. Title*
67. Home Address*
69. 3. Name
70. Title
71. Home Address
73. 4. Name
74. Title
75. Home Address
77. Property Ownership
    Building Owner
79. Building Owner*
80. Email Address
82. Address*
84. City*
85. State*
86. Zip Code*
88. Phone Number*
90. Provide a brief statement of how you will advertise your business and services to attract customers.*
92. Execute*

    1. I agree

    By selecting I agree option below you are giving your electronic signature.
93. No False statements

    It is unlawful for any person to make a false statement on this application.  Any false statement made on this application form will void the application and constitute a misdemeanor punishable as provided by law.

    
    

95. First Name*
    Information for individual completing this form.
96. Title*
98. Phone Number*
99. Email Address*
Leave This Blank:


100. 1. Receive an email copy of this form.
101. Email address

     This field is not part of the form submission.

102. Submit Submit and Print