Location Administrator Request Form

New User Existing User

User Information

Please enter the user account information in the fields provided below. Phone and email information must be accurate and complete in order to process your request. A Tax & License Representative will contact you to confirm the information submitted and will request your social security number prior to creating your account.

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First Name: *

Last Name: *

Date of Birth: *

Phone: *

Email: *

Position: *

Add Location
Please search for the location information you will be filing for below and add it to the list below. You must provide at least one location.

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Location *

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