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2. Merchant and Manufacturer Renewal License Application
4. Name of Business*
5. Contact Name
7. Business Location*
9. City*
10. State*
11. Zip*
13. Mailing Address*
15. City*
16. State*
17. Zip*
19. Email Address*
20. Telephone Number*
22. Missouri Sales Tax Number*
23. Facsimile Number
25. Provide copies of the following documentation or information.
    If applicable please attach the 'No Tax Due Letter' from the Missouri Department of Revenue (Must be issued by the State within 30 days of our receipt of this application)
27. License Fee
    Note: A convenience fee of $2 + 3.95% is required by the payment processor and is included in total.
28. Business Location's Annual Retail Sales/Fee*

    1. $1-$1,000,000 sales = license fee $15 - 15.00
    2. $1,000,001 - $10,000,000 sales = license fee $20 - 20.00
    3. $10,000,001 or more sales = license fee $25 - 25.00
29. Merchandise for Sale*

    1. Manufacturer
    2. Retail
    3. Wholesale
    4. Retail and Wholesale
31. Quantity
32. Shipping Cost
34. Applicants Signature*

    1. Signature

    By checking this box you are signing this online form.
35. Date*
36. Taxable
Leave This Blank:


42. Calculate Totals Proceed to Checkout

* indicates a required field