Barber - Corporate Shop Owner Original License

Business Information:

Name (President):
Name (Vice President):
Corp. Name:
Corp. Address:
City, State Zip: , -
County of Corp. Address:

Note: If you change the name of your shop, the outside signage of the business must be changed to match the shop's name. If the names do not match, you are in violation of the Barber Regulations.
Shop Name/Outside Signage:
Shop Address:
City, State Zip: , -
County of Shop Address:
Business Phone No.: - -

Federal ID:
Name of State in which incorporated and date of Certificate of Incorporation.
State: Date: / /

Resident Agent:

Name (Resident Agent):
City, State Zip: , -
Home Phone No.: - -
Business Phone No.: - -
E-mail Address:

Required Information:

Has the applicant or any of the corporate officers or management personnel of this corporation:
1. Ever been convicted of a felony or misdemeanor in any State or Federal court? Yes No
2. Ever had this type of license denied, suspended, or revoked by Maryland or any other State? Yes No
3. Been convicted of or received probation before judgment of any drug offense committed after January 1,1991? Yes No

Workers Compensation:

 I have Workers Compensation Coverage   Policy/Binder No.

Issued by the  

 I am not an employer required to provide employee coverage under the Workers Compensation Law.


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