2. First Name:*
3. Last Name:*
5. Telephone Number:*
7. Email Address:*
9. Date Requested:*
   Date Requested:

   (Must be 3^rd Saturday of Every Month)

10. Time Requested:*
    -- Select One --10:00 a.m.10:30 a.m.11:00 a.m.11:30 a.m.12:00 p.m.12:30 p.m.1:00 p.m.

    (Must be between 10:00am and 1:00pm)

12. Please identify one of the following for which you are requesting fingerprint services:*

    1. Liquor License Applicant

    1. Massage License Applicant
14. Please provide the following employer information:
16. Business Name:*
18. Street Address:*
20. Please acknowledge the below requirement(s):*

    1. Payment of $100.00 must be paid at the time of the appointment. Cash or checks are accepted. Checks can be payable to the City of Wheaton.
22. 1. A completed, signed and notarized Liquor License Applicant / New Manager Application must be submitted to the City Clerk prior to appointment at arosedale@wheaton.il.us
24. *A representative from the Wheaton Police Department will contact you to confirm your appointment.
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field