Please Read Carefully Before Signing

Information requested on this application must be provided to obtain an establishment license. Personal information you provide may be used for purposes other than that which it was collected (s.15.04(1)(m), Wis.Stats). Operating without a license is a violation of Wisconsin Law. If you have been operating without a license, you will be required to pay a surcharge in addition to the license fee. Licenses are not transferable between persons or locations. Licenses expire annually on June 30. The license fee is not prorated for partial license years. The Department may inspect premises at any reasonable time. Missing information may delay the issuance of your license. The undersigned hereby certifies that this is a true, complete and accurate application.