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2. Precious Metals & Second Hand License
   Application Fee: $50.00 Each (Non-refundable)
4. Which type of license(s) are you applying for? *

   1. Precious Metals
   2. Second Hand
6. Business Name*
7. Business License Number
8. Phone*
10. Address*
11. City*
12. State*
13. Zip Code*
15. Do you have a separate Corporation/ Business name?

    1. Yes
    2. No
16. Corporation Name
17. Phone
19. Corporation Address
20. City
21. State
22. Zip Code
24. Owner's Name*
25. Phone*
26. Owner's Date of Birth
27. Owner's Drivers License Number
29. Copy of Driver's License Front
30. Copy of Driver's License Back
32. Owner's Address*
33. City*
34. State*
35. Zip Code*
37. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
39. Electronic Signature
Leave This Blank:


41. Submit

* indicates a required field