Business License Application

This application can be printed and emailed through the pdf link below, and sent to t.roberts@galenaks.gov or dropped off at the City Clerks office at 211 W 7th St. Galena, Kansas 66739. For more information contact us at 620-783-5265 ext. 6. You may also fill out the form online and submit. IF you have any questions please give us a call.

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Business License Application

Common Name of Business (DBA) *

Legal Name of Business (if different from DBA)

Type of Business

Examples: Contractor, Physician, Retail Sales, etc.

TAX ID Number *

In house use only.

Licensing Email *

To be used for all notifications regarding business licensing.

Notification Email

If you are interested in receiving emails regarding city events, notifications, or any other non-related business licensing email.

Business Phone *

Fax Number

Business Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Mailing Address

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

If different than the Business Address

Contact Person for Licensing *

First

Last

This is kept private.

Contact Persons Phone *

This is kept private.

Emergency Contact *

First

Last

To be used in emergency situations. This is kept private.

Emergency Contact Phone *

Please list a cell phone number that you can be reached during out of office hours. This is kept private.

Would you like your Business Name, Address, and phone number listed on the City Website Business Directory? *

• Yes
• No

If you are a contractor, please be more specific and tell us what types of services that you provide

If you have a Facebook or Website, and you would like either to be attached to your directory listing on our website, please leave those URL links below.

File Upload

Click or drag a file to this area to upload.

If you are a new business or you have let your license expire, please attach a Certificate of Insurance for your business. If this is not attached there may be a delay in issuing your Business License.

Licensing fees

Fees can be paid over the phone at 620-783-5265 ext. 1 or mailed to 211 W 7th St. Galena, KS 66739.

Submit