Village of Glen Ellyn

ContactUs@glenellyn.org

535 Duane Street, Glen Ellyn, IL, 60137, US

630-469-5000

Fire Prevention Inspection & Emergency Contact Registration

In recognition of the financial burdens facing all businesses due to the COVID-19 pandemic, the Village Board has waived the annual Business Registration Fee for 2022.

Business Information

Business Name

Doing Business As

Illinois Business Tax ID

Business Location

Central Business District

Roosevelt Road

Stacy's Corner

Other

Business Email

Business Website

Will prepared food and beverages be sold for immediate consumption?

Yes

Property PIN

Days and Hours of Operation

Square Footage/Area

Maximum Number of Employees at this Location and 1 Time

Number of Full Time Employees

Number of Part Time Employees

Contact Information

Business Owner

Phone Number

Business Contact Person (if not Owner)

Business Contact Phone Number

Business Contact Email

Property/Landlord Owner

Property Owner Phone Number

Property Owner Email

Emergency Contact Information

Must be available via phone 7 days/week & 24 hours/day

Phone Number 1

Phone Number 2

Phone Number 1

Phone Number 2

Alarm Company Name

Alarm Company Phone Number

Billing Information

If different from Business Information Above

Billing Contact Phone

Billing Contact Email

Business Owner Signature

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Date