Application For Secondhand Dealer Or Pawnbroker License

Required fields are denoted with an asterisk

A. Type of Application

Application For Pawnbroker License (21300 FC)
Application For Secondhand Dealer License (21641 B&P)

B. Licensing Agency

Name: Rohnert Park Department of Public Safety
ORI: CA0490400
Mailing Address: 500 City Center Drive
Rohnert Park, CA 94928

C. Business Owner(s)

Name

DOB(mm/dd/yyyy)

Title

Home Phone

Remove Owner

D. Business Information

Name

Phone

Address Line 1

Address Line 2

City

ZIP Code

Business Ownership

INDIVIDUAL
PARTNERSHIP
CORPORATION

Corporation

Name

Phone

Corporation Address

Address Line 1

Address Line 2

City

State

ZIP Code

E. Off Site Storage Location

Will property belonging to the business be stored off the business premises? Yes No

Off Site Storage Address

Address Line 1

Address Line 2

City

State

ZIP Code

F. Multiple Secondhand Dealer or Pawnbroker Businesses

Do any of the parties to this application have a financial interest in any other secondhand dealer or pawnbroker businesses in California? Yes No

Other Pawn or Second Hand Business Information

Name

License Number

Phone

Other Pawn or Second Hand Business Address

Address Line 1

Address Line 2

City

ZIP Code

Additional info reported to LEA

Remove Business

G. Store Administrator

Name

Phone

Email Address

Verify Email Address

H. Certification

As the person responsible for completing the application for the business, I certify under penalty of perjury that the information on this application is true and complete to the best of my knowledge.

Application For Secondhand Dealer Or Pawnbroker License

A. Type of Application

B. Licensing Agency

C. Business Owner(s)

D. Business Information

Business Ownership

Corporation

E. Off Site Storage Location

Off Site Storage Address

F. Multiple Secondhand Dealer or Pawnbroker Businesses

Other Pawn or Second Hand Business Information

Other Pawn or Second Hand Business Address

G. Store Administrator

H. Certification