INS - Application for Wholesale Fireworks

Application for Wholesale Fireworks

SFN 52620
Applying for*

New LicenseLicense Renewal
Applicant Name (if a corporation, limited liability company, etc., enter legal name)
Business Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Person to Contact Regarding Application Questions
Phone Number of Contact Person
Please enter a valid phone number.
Email of Contact Person
example@example.com
Applicant applies for a license to sell fireworks as required by North Dakota Century Code Chapter 23-15 for the following location:

Street Address

Street Address 2

CityState

Zip Code
County

Said applicant is aware of all State and Local laws, regulations and rules pertinent to the storage and sale of Class C fireworks which may be legally offered for sale and, also agrees to follow the guidelines listed in Chapter 10-07-01 of the North Dakota Administrative Code regarding the storage, transportation, sale and usage of said fireworks.
Due to the nature of type of business being done, the following administrative and statutory requirements must be met by said applicant, according to the type of sales conducted:
Fire extinguishers are placed in premises in accordance with provisions for high hazard occupancies (1A rating for every 1,000 square feet). Exits must be provided under applicable state and local codes for protection of customers and occupants of premises. Smoking must be prohibited within the premises being licensed. No open flames are allowed within licensed premises. Adequate exits must be provided within sales areas. State laws concerning fireworks sales and usage must be posted.
I hereby affirm that I have read the above rules, regulations and North Dakota state laws relating to the sale of fireworks and understand them. I also agree to post the license in a conspicuous place at each location from which I intend to sell fireworks.
Name of Individual Authorized to Sign on Behalf of Applicant (Print Name)
Official Position
Signature of Authorized Individual*

Clear
Date

MonthDayYear
Date

My Products*

Fireworks application fee

$250.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country