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2. Application Type
   -- Select One --NewRenewal
6. I. Name
8. Business Name
10. Contact Person
14. II. Applicant's Current Registration # (if renewal):
18. III. Federal Sales Tax ID#
22. IV. State Sales Tax ID#
26. V. Physical & Mailing Address
28. Physical Address
30. City
31. County
32. State
33. Zip Code
35. Mailing Address
37. City
38. County
39. State
40. Zip Code
44. VI. Contact Information
46. Home Phone
47. Mobile Phone*
49. Email*
53. VII. Describe Specific Business Activity for which Registration is Desired
57. VIII. Storage Address or Point of Transport Origin
59. Address
61. City
62. State
63. Zip Code
67. IX. Point of Disposition or Transport Destination
69. Address
71. City
72. State
73. Zip Code
77. Application is hereby made for registration to store, handle, possess and transport bottle rockets in the state of Kansas for use outside the state of Kansas in accordance with K.S.A. 31-507 et seq.
81. X. Applicant's Signature
    Under penalties imposed by K.S.A. 21-3805, I declare that I have examined this application and any documents submitted in support thereof, and to the best of my knowledge and belief, they are true, correct and complete. I also certify that I am familiar with all published state laws and local ordinances relating to firework materials for the location(s) in which I intend to do business.
83. By typing your name and date below, you attest that the information contained herein is true and accurate.
85. Applicant Name
86. Date
Leave This Blank:


88. 1. Receive an email copy of this form.
89. Email address

    This field is not part of the form submission.

90. Submit

* indicates a required field