Business License No.
Business/Trade Name:
Address:
City:
State: 
Zip: 
Telephone Number:
Reason For 
Business Closed
Service Canceled 
Owner Changed
Effective Date 
New Owner's Name:
Address:
City:
State: 
Zip: 
Telephone Number:
  Owner's Name:
(Person Completing this Form)
Phone: 
Address:
Date: 
Signature
PLEASE NOTE: Future requests for a business license requires a new application
and approval
OFFICE USE ONLY
Memo:   Outstanding Obligations to DLCA $ _________________    Approved By: _________________ 
Government of the Virgin Islands
Tel. 340-718-2226
Department of Licensing and Consumer Affairs
Fax 340-718-6982
3000 Estate Golden Rock
Christiansted, VI 00820
BUSINESS LICENSE HOLD/TERMINATION FORM
Please give a breif explanation for the action taken:
 
Business No.:
License Category:
 (list categories to be
held or terminated)
Termination
Hold
APPLICATION PRESENTED UNDER NEW ENTITY.