Request A License

* Name of Establishment:
Establishment Address
Street:
City:
State:
Zip:
* Contact Person:
Title:
Phone Number:
* E-mail address:
Mail To Address if Different
Street:
City:
State:
Zip:
Type of Establishment
Bowling Center:
Number of Lanes:

Concert Promoter:

Country Club:
Number of Full Time, Part Time and Associate Members:

Dance School

Festival
Number of Days:
Music Oriented?	Yes No

Health and Fitness Center

Hotel, Motel and Resort
Number of Rooms:
Average Room Rate:
Live Music?	Yes No
Recorded Music?	Yes No
In Room Pay Per View Movies?	Yes No
Meeting Rooms/Banquet Facility?	Yes No

Internet/New Media
Average Number of monthly Page Requests:
Paid Advertising on Web Site?	Yes No

Music In Business
Number of Employees:

Restaurant, Nightclub, Tavern
Establishment Capacity:
Mechanical Music?	Yes No
Dancing?	Yes No
Admission or similar charge?	Yes No
Live Music?	Yes No
If yes, number of days per week?:

Retail Store
Gross square Footage:

Shopping Center/Mall
Gross Leaseable Area:

Skating Rink
Number of Months Open:
Days/Nights Open:

Stadium, Arena, Convention Center
Maximum Seating Capacity:

Theme, Amusement, Water Park
Annual Attendance:

Other (please describe music use and type of business):

Which License Do You Need?