Alcohol License Application

Alcohol License Application

Orem Business License Department | 56 N Center Street Floor 2 | Orem, UT, 84057 | 801-229-7198
License #
Payment Date

MonthDayYear
Date
Required submittal of $
And the items listed below as application for a
CLASS __ Alcohol License
Required Documentation Checklist (Attach to this form):
- City of Orem Business License
- Floor plan of business premises outlining where alcoholic beverages are kept, stored, and sold
- Proof of Commercial General Liability Insurance
- State of Utah, B.C.I. Background Check
- Copy of temporary State Issued Alcohol License (Class B&E Only)
- Cash or Surety Bond for $1,000 (Class D Only)
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Business Information
Business Name
Federal Tax ID# (EIN)
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Locations of other alcohol/beer licenses held in the State of Utah:
Owner Information
Business Owner Name

First NameLast Name
Previous Owner Name, if applicable

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Manager Information
Business Manager Name

First NameLast Name
Previous Manager Name, if applicable

First NameLast Name
Date

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Manager Email
example@example.com
Manager Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Alcohol License Fee Schedule
If a license is issued for less than a full year, the fee is pro-rated and reduced by 25% for each full quarter, calculated from July 1st, with the exception of the Local Consent Fee. License are non-transferable and will expire upon change of ownership.
Only one signature is required if the applicant is a partnership, association, corporation, franchisee, or other business entity. However, complete information on all officers, managers, partners, directors, members, or owners must be provided.
I, the undersigned, understand and agree to comply with all regulations of Chapter 3 of the Orem City Code, Alcoholic Beverages. I hereby hold harmless the City of Orem, Department of Public Safety, and all others from liability or damage which may result from furnishing the information requested. I hereby grant any authorized representative of the City of Orem or law enforcement officer the unrestricted right to enter the licensed premises during business hours.

I certify that I have never been convicted of a felony. I certify that I have never been convicted of any violation or any law or ordinance relating to alcholic beverages, or any crime involving moral turpitude, and that I have never had any license or permit involving alcoholic beverages revoked within the last three years.

I also certify that I have complied with the requirements, and posess the qualifications specified in the Alcoholic Beverage Control Act of Utah, and that all the information I have provided in the application is true. I agree that if a license is issues, it shall be subject to suspension or revocation as provided in Chapter 3 of the Orem City Code.
Signature
Date

MonthDayYear
Date
Printed Name

First NameLast Name
Title
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Alcohol License Application

Business Information

Owner Information

Manager Information