2. APPLICANT INFORMATION
Please do not use the browser back button. Use the tabs above to navigate your application, otherwise you may not see or submit current information with the IGB.
Doing Business As (D/B/A):
Street address of premises to be licensed:
City / State / Zip Code:
County:
Mailing address (if different than premises):
City / State / Zip Code:
Foreign state / foreign country (if applicable):
Foreign phone / foreign zip (if applicable):
Email address:
Email CC to (separate multiple with comma):
Website address (if available):
Illinois Business Authorization Certificate of Registration Location Code:
Illinois business tax (IBT) #:
iltax.com
IL liquor license # / expiration date:
IL LCC
Local liquor license # / expiration date:
Local liquor license issuing authority:
Applicant's Business Structure*:
Date Formed:
Date Formed:
Date of incorporation:
Date of incorporation:
Market trading (ticker) symbol:
Date of incorporation or formation:
State where Applicant formed or incorporated:
* If you select a different business structure in the future, all partners/shareholders/members will be removed and you will need to add them again on the Business/Individual Interests page.
Upload a PDF copy a current flowchart illustrating the fully diluted ownership of the Applicant. List all parent, holding or intermediary companies until the flowchart reflects the stock, partnership or Ownership Interest as being held by an Individual natural person, and not another Business Entity or entities, If the ultimate parent company is a Publicly Held Company and no Individual controls 5% or more of the publicly traded stock, indicate that on the flowchart.
example
Registered Agent:
find agent
Address:
City / State / Zip Code:
Business phone (###-###-####):
Email address:
Legal Services Representative (if applicable):
Address:
City / State / Zip Code:
Business phone (###-###-####):
Email address:
Information was last saved on mm/dd/yyyy