Request to Close a Business in Orem

Today's Date

Business License Number:

Business Name:

Registered Owner Name:

Close Business as of:

I am at least 18 years of age and I hereby warrant and affirm that the information provided in this form is true and correct to the best of my knowledge.

Requested by:

Requestor's Email

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Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.