Tobacco Product Retail License

2. Applicant Information
4. Business Owner First Name*
5. Business Owner Last Name*
7. Email Address *
8. Phone Number *
10. Home Address *
12. City
13. State
14. Zip
16. Mailing Address *
18. City *
19. State*
20. Zip *
22. Legal Name (Corporation, LLC, Partnership)*
23. Trade or Business Name *
25. Business Physical Address *
27. City*
28. State*
29. Zip*
31. Business Mailing Address *
33. Business Phone Number*
34. Fax Number
36. Business Email Address
38. Description of Business Type*
40. Authorized Agent *
    Person(s) authorized to receive all communications and notices from the Town of Telluride.
42. License Information & Fee
    A license fee of $175.00 must be submitted for an application to be considered. Payment can be remitted by calling the Telluride Finance Department at (970) 728-8436 or in-person at Town Hall, 135 W Columbia Avenue. A license will not be issued until a complete application is submitted, the license fee has been received, and approval is granted by the Telluride Tobacco Product Licensing Authority.
44. Electronic Signature*

    By checking "I agree" you agree and acknowledge your electronic signature is valid and binding in the same force and effect as a handwritten signature, that all the information contained in this application are true, correct and complete to the best of your knowledge, information, and belief, and that you have read and understand Telluride Municipal Code Chapter 6, Article 7 Tobacco.

    1. I Agree
46. Digital Signature *
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit Submit and Print

* indicates a required field