Form Center

2. Business Closure Form

   This form is ONLY to be used if the business operating/doing business within the city limits of Rogers has ceased operations permanently, or moved out of the jurisdiction. A separate form will be required for multiple closed business locations.

6. Business Information
8. Business license number*
10. Business Name*
12. Business Address*
13. Ste/Bldg #
17. Closure Details
19. Date Business Closed*
    Date Business Closed
21. Please select the option that applies:*
    -- Select One --Business dissolved, no longer existsBusiness moved outside of Rogers city limitsSold business - please provide new owner details belowOther - please provide details
23. Please provide details*
25. If the business has changed ownership, please fill out the following information below on the new owner:
27. New Owner Name
29. New Owner Email
30. New Owner Phone Number

34. I hereby certify that I am not doing business at the above business address and declare under penalty of perjury, that I am authorized to complete this application. To the best of my knowledge and belief, the provided information is true and correct.

36. Signature of Applicant*
37. Date*
    Date
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field