Online Business Application

Business Information

Is your business home based?
(If "yes" you will also need to fill out a home occupation permit form.) YesNo

Please check on the following: New BusinessChange of OwnershipExisting Business, change of Address

*Actual Business Startup Date:(At this location)*	(mm/dd/yyyy)
Number of Full Time Employees:(At this location)
Form of Business:
Business Name:
Description of Business:
*AR Sales Tax#:Enter "N/A" if you do not have an AR Sales Tax #*
DBA Name: (if applicable)
**Telephone:	(no dashes or spaces)
Fax:	(no dashes or spaces)
**Email:

License Address:

**Address 1:
Address 2:
**City:
**State:
**Zip

Mailing Address: (if different from above)

Address 1:
Address 2:
City:
State:
Zip

Business Owner

**Business Owner Name:
**Home Address:
**City:
**State:
**Zip
Home Phone:

Optional (For Statistical Purposes Only)

Gender:
Race:

Previous Business Location

Address:
City:
State:
Zip

Check any of the following that apply:

This business sells tobacco.

This business sells alcohol.*
* Please provide copies of State permits.

This business maintains inventory.Amount of Inventory: $

Are you currently involved with or do you plan any construction or remodeling at this location?

Do you store or stock flammable or explosive materials?
Note type and quantities:

NOTE: A false statement or misrepresentation may make the license null and void and constitute forfeiture of any fees paid.

You will not be able to apply for your business licencse unless you agree that the above information is true. If you do not agree, please contact the Treasury Managment Division at (501) 371-4568.
I Agree

Signature of Owner or Representative:
First Name:
Last Name:

Owner or Representative Phone Number:
Date: