2. Business Information
4. Common Business Name/DBA Name
6. Business Address 1*
8. City*
9. State*
10. Zip Code*
    -- Select One --018400184101843
12. Business Phone Number*
14. Does this business have a retail food or liquor license ? Check all that Apply*

    1. Liquor
    2. Food
    3. Other
16. Business Contact
18. First Name*
19. Last Name*
21. Home Phone Number*
23. Address2
25. Business Address*
27. Occupation*
29. Email Address
31. Residency Information
33. Length of Residency in League City*
35. Are you a registered voter*

    1. Yes
    2. No
37. Education and Hobbies
39. High School
41. College
43. Trade or Business School
45. Hobbies
47. Do you have landlord or property owner consent? *

    1. Yes
    2. No
49. Do you plan to use a public right-of-way (e.g., sidewalk, street) or private property located in front of another business? (Please note that an agreement with the impacted businesses may be required.)*

    1. Yes
    2. No
51. Please list organization memberships and positions held
53. Please List Areas of Special Interest
55. Please Enter Basic Resume Information Below
Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit Submit and Print

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