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2. Select One*

   1. New Application
   2. Renewal
4. Name of Business*
6. Name of Manager*
8. Name of corporation (if different than name of business)
10. Business Street Address*
12. Business Mailing Address (if different than street address)
14. Phone Number*
16. Email Address*
18. Please describe the entertainment you are seeking to hold at your businesses. Types of entertainment include but are not limited to: Dancing; recorded or live music; the use of an amplification system; trivia; karaoke; disc jockey; comedy; a floor show of any description; a light show of any description; a theatrical exhibition, play or moving picture show; any other dynamic audio or visual show, whether live or recorded.*
20. Please describe the set up of the entertainment layout and attach a floor plan.
22. Floor Plan*
24. Does your business have a current:*

    1. Alcohol License

    1. Common Victualler License
26. This license only covers entertainment Monday-Saturday. For Sunday entertainment, a state form is required and fees are required to be submitted to the state. Please see https://www.mass.gov/sunday-license*

    1. Click the box to acknowledge.
28. Additional Comments
30. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
32. Electronic Signature
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field