[City of Baraboo] Cigarette, Tobacco and Electronic Vaping Device Application, CTV-100

Hello Applicant. You are about to apply for a license for retail sales of tobacco products and/or electronic vaping devices. Here are a few pointers to help you along the way:

Before beginning this application you should gather:

1. Completed Appointment of Agent form (CTV-102) (This form can be printed from the City's website)

2. Completed Individual Questionnaire forms (CTV-101) for ALL persons involved in the business. This includes sole proprietors; all officers & agents of a corporation; all partners of a partnership; and all members & agents of an LLC. (This form can be printed from the City's website)

3. FEIN

4. 15 digit Wisconsin Sales Tax Account Number

5. Business name, address, phone number, email address

6. If incorporated, know the date of incorporation and your Wisconsin DFI registration number

NOTE: Any application submitted without the Individual Questionnaire's will be considered incomplete. IF submitting the application online, paper copies of the questionnaire form will not be accepted.

If you have to quit before finishing you do have the option to save and come back later.

Payment of $100 is required at the end of the process. Payment options include : online, US mail, or in person. After completing the application and payment, please allow for up to 15 days for processing. If you have any questions, please contact the City Clerk at 608-355-2700.

Please check that you agree before continuing.

By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.

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Listed Signers

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PREPARER
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Other Signers (The signers below will be invited to sign once the above signers have signed.)

	Linda Wiese
	Police Chief
	CLERKS

City of Baraboo

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Please attach a copies of your Appointment of Agent and all applicable Individual Questionnaire(s).

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Please provide accurate information below to ensure the delivery of the signed copies of the document.

Listed Signers

Other Signers (The signers below will be invited to sign once the above signers have signed.)

Linda Wiese

Police Chief

CLERKS