Smoke Shop License Application

SMOKE SHOP LICENSE APPLICATION

RECITALS

WHEREAS, the applicant seeks a municipal license authorizing the retail sale of tobacco, vapor products, and smoking paraphernalia from the premises identified in this application; and

WHEREAS, issuance of such a license is conditioned upon review of the applicant's qualifications, background information, payment of applicable fees, and compliance with applicable law and local regulations; and

WHEREAS, the applicant acknowledges that submission of this application does not constitute approval and that the licensing authority may impose conditions, refuse, suspend, or revoke a license in accordance with law.

APPLICANT INFORMATION

Sole Proprietorship    Partnership    Corporation    Limited Liability Company (LLC)

OWNERS / OFFICERS (List all persons with 10% or greater ownership)

PREMISES & OPERATIONS

Floor plan submitted with this application

PRODUCTS TO BE SOLD

Select all product categories to be sold from the licensed premises:

Cigarettes / Tobacco Products    Electronic Cigarettes / Vaping Products    Smoking Paraphernalia    Hemp-derived / CBD Products

PAYMENT & LICENSE TERMS

License Fee Amount:

TERM AND TERMINATION

The licensing authority may suspend or revoke a license for cause, including but not limited to: violations of applicable laws or regulations, sale to underage persons, material false statements in this application, or failure to pay fees when due.

BACKGROUND & COMPLIANCE QUESTIONS

For each question below, check the appropriate box and provide explanation and documentation where indicated.

Has the applicant or any listed owner/officer been convicted of a felony affecting business fitness?
Yes    No

Has any license issued to the applicant or any owner/officer ever been suspended or revoked?
Yes    No

The applicant agrees to implement and maintain age-verification procedures to prevent sales to persons under legal age and to comply with all applicable health and safety rules.
Applicant affirms compliance and will maintain records evidencing age verification

ATTACHMENTS CHECKLIST

Please check all documents included with this application:

Government-issued photo identification for owners/officers
Federal Tax ID confirmation or SSN documentation
Lease or proof of premises ownership
Premises floor plan
Background check authorization / reports

CONFIDENTIALITY

Information submitted in this application will be used to evaluate fitness for licensure. Applicant acknowledges that certain information may be public records under applicable law. The licensing authority will protect confidential financial or proprietary information to the extent permitted by law, but makes no guarantee of confidentiality for information required to be disclosed.

GOVERNING LAW & ENTIRE AGREEMENT

This application and any license issued pursuant to it shall be governed by the applicable laws and local ordinances. Submission of this application constitutes the entire understanding between the applicant and the licensing authority with respect to the matters herein; no oral statements or other writings modify these terms unless expressly accepted in writing by the licensing authority.

CERTIFICATION AND ACKNOWLEDGMENT

I certify under penalty of perjury that the information provided in this application and in any attachments is true, correct, and complete to the best of my knowledge. I authorize the licensing authority to investigate the statements contained herein and to obtain criminal, civil, regulatory and financial records necessary to determine suitability for licensure. I understand that providing false or misleading information is grounds for denial, suspension, or revocation of any license granted.

Applicant agrees to comply with all applicable laws, including restrictions on sales to minors, health and safety requirements, recordkeeping obligations, and any conditions placed on the license. Applicant acknowledges that issuance of a license may be conditioned on inspection of premises and verification of compliance.

Sign Now