Form 08-4075 - Concert Promoter Registration Application Packet Page 3
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7CPR
State of Alaska
For Division Use Only
Department of Commerce, Community and Economic Development
Division of Corporations, Business and Professional Licensing
CONCERT PROMOTER SECTION
th
State Office Building, 333 Willoughby Avenue, 9
Floor
PO Box 110806, Juneau, AK 99811-0806
Phone: (907) 465-2695
E-mail: license@alaska.gov
Website:
CONCERT PROMOTER REGISTRATION APPLICATION
Nonrefundable Application Fee - $125
Initial Registration Fee - $800
Part I: COMPANY INFORMATION
Type or Print Legibly
Business Name:
Doing Business As:
(DBA – if applicable)
Address
Complete
Mailing Address:
City
State
Zip Code
Address
Complete
Physical Address:
City
State
Zip Code
Business Phone:
E-Mail:
Part II: OWNERSHIP
Check applicable box and provide complete names and addresses of owner, all partners, or corporate officers,
whichever is appropriate, and provide U.S. social security numbers of proprietor or partners.
Sole Proprietorship*
Partnership*
Corporation
Federal Employer I.D. #
*Date of Birth
*U.S. Social Security #
Name
Address
*For Sole Proprietor or Partners
CONTINUED ON REVERSE
08-4075 (Rev. 06/11/13)
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