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PLC:

a006o5

Agency:

city of crowley

For:

beer/liquor application fee

Phone:

337-788-4100

Address:

425 n parkerson avenue
crowley, louisiana 70526

*Required Field

Payment Information

*Owner Name:

Middle:

*Last:

*Owner Type:

*Trade or Business Name:

*Owner Driver's License number:

*State Driver's License issued in:

*Last 4 digits of Owner's Social Security Number:

*PO Box or Mailing address:

*City:

*State:

*Zip:

*Location Address:

*City:

*State:

*Zip:

*Parish:

Ward:

*Phone Number:

(### - ### - ####)

*Cell Phone Number:

(### - ### - ####)

*Email:

*Type of Permit Sale:

*Type or Class of Permit:

*Permit Fees:

Failure to file application before beginning business or renewal permit not later than Nov. 1 of each year will incur penalties to include 25% of permit fee

Payment Amount

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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