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Merchant and Manufacturer Renewal License Application (Renewal Only)

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

40. Denied

    1. Yes

    1. No

41. Reason

43. Approved

    1. Yes

    1. No

44. License Number

46. Processor

Leave This Blank:


47. Calculate Totals Proceed to Checkout

* indicates a required field