2015 Antique Dealer Itinerant Junk Dealer Pawn Broker ...

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2015 ANTIQUE DEALERS, ITINERANT MERCHANTS, PAWN BROKERS
AND SECOND HAND DEALERS BUSINESS LICENSE APPLICATION

Office of the City Clerk - Business Services Office Use Only:

150 West Jefferson Street Date Received: ___________

Joliet, Illinois 60432 Date Issued: ___________

Office 815-724-3905 Fax 815-724-3904 Control Number: ___________

Website: www.cityofjoliet.info Email: [email protected]

This application pertains to the following type of businesses: Antique Dealers, Itinerant
Merchants, Pawn Brokers and Second Hand Dealers.

Please print legibly. All information and supplemental requirements must be completed and
submitted. Incomplete forms will be returned. Please allow a minimum of ten business days for
processing and review prior to opening.

New Business: ______ Renewal: ______ Change of Ownership: ______ Expansion: ______
Proposed Opening Date: ____________________ Date Opened: ___________________________

GENERAL INFORMATION
LOCAL BUSINESS INFORMATION
Local Business Name: ______________________________________________________________
Store Number: ____________________________________________________________________
Local Business Address: ____________________________________________________________
City: _________________________ State: __________ Zip Code: _______________________
Local Business Telephone Number: ___________________________________________________
Local Business Fax Number: ________________________________________________________
State of Illinois Business Tax Number (IBT - Submit IDOR Certificate of Registration): _______________________
Emergency Telephone Number (after hours): ____________________________________________
Owner/Manager Name: _____________________________________________________________
Owner/Manager Home Address: ______________________________________________________
City: _________________________ State: __________ Zip Code: _______________________

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CORPORATE BUSINESS INFORMATION
Corporate Name: __________________________________________________________________
Business Name (DBA): _____________________________________________________________
Contact Name: ____________________________________________________________________
Mailing Address: __________________________________________________________________
City: _________________________ State: __________ Zip Code: _______________________
Telephone Number: _________________________ Fax Number: __________________________
E-mail Address: _______________________________ Website Address: _________________
Federal Employee Identification Number (FEIN Submit IRS Dept. of Treasury Authorization): ___________________
Check mailing address for all correspondence: Local Address: _____ Corporate Address: _____
Do you want the local business name, address and telephone number listed on the City of Joliet’s
website? Yes: _____ No: ______

BUSINESS OPERATION INFORMATION
General description of business: ______________________________________________________
Gross square footage of tenant space at location: ________________________________________
Total number of employees at location (include family members): ____________________________
Hours of operation at location: _______________________________________________________
Is the business located in a stand-alone structure? Yes: ______ No: ____

If no, name of center: __________________________________________________________
Does the business own the building? Yes: _____ No: _____ If no complete following:

Owner/Property Manager Name: _________________________________________________
Owner/Property Manager Address: _______________________________________________
City: ________________________ State: ______________ Zip Code: _____________
Owner/Property Manager Telephone Number: ______________________________________
Are hazardous materials stored on site? Yes: ____ No: ____ If yes, state location on-site where
files are found: ____________________________________________________________________
Does the business have an alarm system? Yes: ___ No: ____ Must register with Police Dept.
Name of Alarm System Monitoring Company: ______________________________________
Are there food vending machines or coin operated amusement devices on the property?
Yes: ___ No: ___ If yes, the “Coin Operated Vending, Amusement and Gaming Devices
Business License Application” must be completed and all machines must have individual
annual stickers
Name of Vending Company or Person: ______________________ Phone Number: ____________

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BARTER, PAWNED, PURCHASE, SALE OR TRADE OF SECONDHAND ITEMS
Select the category or categories which best explain the business:

____ Antique dealer ____ Consignment store ____ A/V equipment, gaming devices

____ Jewelry / Gold store ____ Automobile and/or parts resale ____ Pawn broker/shop

____ Junk / Salvage yard ____ Charity store (donated goods for resale) ____ Coin dealer

____ Weapons ____ Itinerant merchant (buying used merchandise at a temporary location & basis)

Other, explain: ____________________________________________________________________

________________________________________________________________________________

The approximate percentage of business associated with the buying and selling of used
merchandise: _____________________________________________________________________

Are the secondhand items being sold purchased new by the business? No: _____ Yes: _____

If yes, please explain: _________________________________________________________

BUSINESS OWNERSHIP INFORMATION
Provide the following information regarding how the business was created and is owned:

___ Individual (Sole Owner) ___ Partnership ___ Limited Liability Corporation (LLC) ___Corporation

Legal Business Name: _____________________________________________________________

If this is a partnership, provide name, address, and telephone number of all partners. If this is an
LLC, provide the names, addresses and percentage of ownership held by each member. If this is a
Corporation, provide the names and addresses of all persons holding three percent (3%) or more of
the stock of the corporation and the percentage of ownership held by each member. If additional
space is needed, add a separate page.

Name: ________________________________________ Title: _________________________
Address: ______________________________________________________________________
__________________________ State: __________ Zip Code: __________________
City: __________________________________ Percentage Ownership: ________________
Phone:

Name: ________________________________________ Title: _________________________

Address: ______________________________________________________________________

City: __________________________ State: __________ Zip Code: __________________

Phone: __________________________________ Percentage Ownership: ________________

I hereby certify that the information provided in this application is true and correct to the best of my
knowledge and that I have not provided false or misleading information. I understand that the failure
to supply adequate or correct information will be subject to suspension or revocation of the City of
Joliet’s business license. I understand the required documenting process and the business will
adhere to it at all times.

________________________________ __________________________________________
Name of Applicant (print) Signature of Applicant

________________________________ __________________________________________
Title of Applicant Date

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