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2. If you have sold or closed a business, please complete the form below. [ * Indicates Required Field ]
4. Today's Date*
   Today's Date*
5. Account Number*
7. Business Name*
8. Location*
10. Is this Business Selling or Closing?*
    -- Select One --Sold/SellingClosed/Closing

    Select One
11. Date Sold/Closed*
    Date Sold/Closed*
13. If Closed/Closing Disposition of Equipment is Required*
    -- Select One --Kept for personal useDonatedDisposedSold off (auction, garage sale, etc.)In storage
15. If Sold, New Owner Information is Required
17. New Owner Name
18. New Owner Business Name
20. New Owner Address
21. City
23. State
24. Zip Code
25. Phone
29. Information Provided By:*
31. First Name
32. Last Name
34. Phone Number*
35. Email Address*
37. Comments
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field