Licensee Contact InformationContact Name/TitleSS#Legal Entity Business NameFed. Tax ID #Entity TypeState of FormationDoing Business AsStreet AddressCityZIP / Postal CodeBusiness PhoneMobile PhoneFaxEmailWebsiteProposed Business InformationLocation Type RMU Kiosk In-line Space OtherLength of agreement desiredProjected opening dateBusiness descriptionWhat is the average price of the products you want to sell?What are your projected sales?Business ExperiencePlease describe the type of businessWhat is/was the name os the retail business?Date of Occupancy?What type of business? RMU Kiosk In-lineWhat are/were the average sales of your retail business?Please list the current or previous locations of your retail business:Please list the current and/or previous locations of your retail business:Business ReferencesName/ TitleType of BusinessAddressPhone Number
