City of Los Angeles
NEWS STAND INFORMATION

FIRST NAME *
LAST NAME *
ADDRESS *
CITY *
STATE *
ZIP *
TELEPHONE (Area Code 1st) *
FAX (Area Code 1st)
E-MAIL

MAILING ADDRESS:
ADDRESS
CITY
STATE
ZIP

BUSINESS LICENSE NUMBER *

LOCATION ADDRESS:
ADDRESS
CITY
STATE
ZIP
LOCATION DESCRIPTION *
START DATE *(mm/dd/yyyy)