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2. 
3. TOBACCO LICENSE FEE
   Annual and Renewal fee is $250.00.
4. License Type*

   1. New
   2. Renewal
6. LICENSE WILL BE EMAILED TO APPLICANT
   Please make sure the email address listed is accurate. Recipient should print and post the License upon receipt.
8. Legal Name of Business (include d/b/a)*
9. Email Address of Applicant*
11. Federal Employer ID #*
12. State Sales Tax #*
14. Business PO Box/Mailing Address*
15. Business Phone*
17. City*
18. State*
19. Zip*
21. Business Physical Address *
23. City*
24. State*
25. Zip*
27. Owner/Manager Name *
31. Please answer the following questions with a yes or no answer.
    This section ensures applicant understands the purpose of Tobacco Licensing and regulations of the Town of Eagle.
33. Does the applicant understand that a licensee cannot legally sell tobacco products in the Town of Eagle with out a retail tobacco license?*
    -- Select One --YesNo
34. Does the applicant understand that a tobacco retailer license if approved must be renewed annually?*
    -- Select One --YesNo
36. Does the applicant understand that a licensed business in violation of sections 5.16 of the municipal code may be fined and the tobacco retailer license may be suspended or revoked?*
    -- Select One --YesNo
37. Does the applicant understand that a licensee has the responsibility to instruct his or her employees that selling tobacco products to a minor is against the law? *
    -- Select One --YesNo
39. Does the applicant understand that actions of a licensee’s employees may cause a licensed business to be fined, suspended, or revoked due to a violation under the laws of the Town of Eagle, the State of Colorado, or the United States?*
    -- Select One --YesNo
40. Does the applicant understand that the legal age to purchase tobacco in the Town of Eagle is 21?*
    -- Select One --YesNo
42. Does the applicant understand they are expected to have a written training program for the Eagle Police Department to review during annual compliance checks?*
    -- Select One --YesNo
43. Does the applicant understand that a licensed business will be subject to inspection for compliance within chapter 5.16 of the municipal code and may involve compliance checks by the Town of Eagle police department to ensure that the licensed business is not selling tobacco to minors?
    -- Select One --YesNo
45. To learn more about the Tobacco Licensing Regulations, please click this link for access to our Municipal Code.
    Eagle Municipal Code Section 5.16 Tobacco License Required
47. LICENSE IS VALID ONE YEAR FROM DATE OF ISSUE
    Applicant has 90 days to renew the license without incurring late fees. Late fees are $15 per month.
49. Affirmation of Applicant*

    By Checking this box, I state under penalty of perjury in the second degree, as defined in 18-8-503, Colorado Revised Statutes, that the information contained above is true and correct to the best of my knowledge. I understand that providing false information is grounds for denial, suspension, or revocation of a license. Any person or entity who knowingly violates any provision of Eagle Municipal Code Chapter 5.16 or 9.15 or knowingly fails to perform an act by any provision of this Chapter, commits a Class A municipal offense.

    1. I agree with this Affirmation (required)
51. Submit Application
    Submit Application and On-Line Payment Gateway

    Click link above to submit application. It will direct you to make an on-line payment with a credit card (Visa, MasterCard or Discover) or using your checking account. Exit xpressbillpay to mail a physical check or stop in with payment.

52. Cash or Paper Check Payment Instructions
    Once you submit this form, please mail a check made payable to the Town of Eagle in the amount of $250.00. Mailing Address: PO Box 609, Eagle CO 81631 - Please include business name on your check to ensure accuracy. Cash payments can be made in person at 200 Broadway, Eagle CO.
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit Submit and Print

* indicates a required field