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Entertainment Permit Application

2. Name of Establishment*

4. Street Address*

5. City*

7. Licensee Name*

8. Licensee Phone Number*

9. Licensee Email*

11. Brief Description of Entertainment Type Requested*

13. Day(s) Entertainment Will be Presented*
    Day(s) Entertainment Will be Presented Start Date

    —

    Day(s) Entertainment Will be Presented End Date

14. Time(s) Entertainment Will be Presented*
    Time(s) Entertainment Will be Presented Start Time

    —

    Time(s) Entertainment Will be Presented End Time

16. Electronic Signature Agreement. *

    By selecting the "I Accept" button, you are signing this form electronically. You agree your electronic signature is the legal equivalent of your manual signature.

    1. I Accept
17. Print Name*

Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field