Form Center

2. Massage Establishment License Application Form - Renewal
6. This application must be accompanied by an application for a business license.*

   1. I have already submitted a business license.
   2. I have not yet submitted a business license.
8. Corporate Name/Sole Propietor*
9. Assumed Business Name/DBA*
11. Business Address in Hanover Park*
12. Business Phone Number*
14. FEIN Number or SSN if Sole Proprietor*
16. Days of Operation*

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday
    5. Thursday
    6. Friday
    7. Saturday
17. Hours of Operation*
    Hours of Operation Start Time

    —

    Hours of Operation End Time
19. Number of Employees*
21. Provide a listing and full description of all massage services to be offered.*
25. Applicant Type*

    1. Sole Proprieter/Partnership
    2. Corporation/LLC
27. Name of Applicant*
29. Personal Address of Applicant*
31. City*
32. State*
33. ZIP Code*
35. Applicant Email Address*
36. Phone*
38. Proof of Age*

    Upload written documentation showing the applicant is at least 18 years of age.

40. Past Addresses*
42. Upload Driver's License or State ID*
44. Employment History*
46. Massage History*
48. Have any of the applicants or corporations ever had a past massage license suspended or revoked?*

    1. No
    2. Yes
50. Explaination
52. Violation History*
54. Upload a Copy of the Deed or Lease for Business Location*
56. Employee Roster*
58. Upload a document containing photo ID and state-issued massage license for each employee listed above*
62. Name of Corporate Officer or Director
64. Personal Address of Corporate Officer or Director
66. City
67. State
68. ZIP Code
70. Corporate Officer or Director Email Address
71. Phone
73. Upload Articles of Incorporation and/or Permission to do Business in Illinois
77. No False statements
    Your submission of this form certifies that the information provided is true and correct.
79. Execute*

    1. I agree

    By selecting I agree option below you are giving your electronic signature.
Leave This Blank:


81. 1. Receive an email copy of this form.
82. Email address

    This field is not part of the form submission.

83. Submit Submit and Print

* indicates a required field