COS SALONSHOP.indd

Packet Updated 10/5/16

INSTRUCTION SHEET

Salon/Shop Registration

To apply for registration as a cosmetology salon, esthetics salon, hair braiding salon, nail technology

salon or barber shop under the provisions of the Illinois Barber, Cosmetology, Esthetics, Hair Braiding,

and Nail Technology Act of 1985, read and follow each of the steps as indicated below. This will aid you

in accurately completing your application and eliminate delays in processing. You may not operate a

salon or shop without a Certiﬁ cate of Registration from the Department.

Note: A separate application must be submitted for each location.

STEP I--Application

Use a typewriter or black pen to complete all information requested on the Application for Salon/Shop

Registration.

1. Part I, D, indicate if this application is for a change of ownership. Check box and write salon or shop

registration number of previous owner. Also, request that previous owner forward a signed, dated

letter acknowledging change of ownership and return original certiﬁ cate of registration to the

Department.

2. Part II, indicate if salon or shop is owned by a sole proprietor, corporation, limited liability

company (LLC) or partnership. Indicate all owner information as requested.

Application must include the name, address, and telephone number of the proprietor, corporation,

LLC, or partnership that owns the salon or shop. If the owner is a corporation, LLC, or partnership,

the application must also include the name, address, email address and telephone number of the

corporate ofﬁ cer or business partner who can be contacted during regular business hours. It must

also include the location of the services.

3. Part III, indicate all salon or shop information as requested.

Application must include the name, address, and telephone number of the salon or shop.

Note: The Department may reject any application including a business name that states or

implies a service that cannot be legally offered by the business, which is misleading to

consumers, or is otherwise inconsistent with the purposes of the Act.

4. Part IV, read certifying statement and sign and date application.

Upon approval of the application, your new license will be printed and mailed to the salon / shop

address. Once you receive your license, you may open for business.

DPR-COS S/S REG 08/16 (COS)

ALL REQUIRED SUPPORTING DOCUMENTATION MUST BE SUBMITTED

with the application and required fee unless otherwise directed in the instructions.

Instruction Sheet

Page 1

STEP II--Registration Fee

A $40.00 check or money order made payable to the Department of Financial and Professional Regulation.

Fee is not refundable.

STEP III--Supporting Documents

Illinois Corporation:

Include a copy of entire Articles of Incorporation as ﬁ led with Illinois Secretary of State.

Foreign Corporation (those incorporated outside of Illinois):

Include a copy of entire Articles of Incorporation as ﬁ led with jurisdiction where corporation is registered;

Include a copy of certiﬁ cate of authority to transact business in Illinois as ﬁ led with Illinois Secretary of State.

Limited Liability Company:

Include a copy of entire Articles of Organization as ﬁ led with Illinois Secretary of State.

Partnership:

Include a copy of signed and dated partnership agreement.

Franchise:

Include a copy of signed and dated franchise agreement. Must show that franchisee has been granted right to

use trade name, trademark, service name, service mark, or any other right to the exclusive use of names or

symbols.

Assumed Name:

Sole proprietor--Include a letter or certiﬁ cate from county clerk’s ofﬁ ce where assumed name is ﬁ led.

Corporation--Include a letter or certiﬁ cate from Illinois Secretary of State authorizing corporation to transact

business under assumed corporate name.

Limited Liability Company--Include a letter or certiﬁ cate from Illinois Secretary of State authorizing LLC to

transact business under assumed limited liability company name.

Partnership--Include a letter or certiﬁ cate from county clerk’s ofﬁ ce where assumed name is ﬁ led.

STEP IV--Mailing Information

Mail application, fee, and supporting documents to:

Illinois Department of Financial and Professional Regulation

ATTN: Division of Professional Regulation

P.O. Box 7007

Springﬁ eld, IL 62791

If assistance is needed, direct your request to:

Department of Financial and Professional Regulation: 1-800-560-6420

TTY: 1-866-325-4949

When an operator answers, state the profession for which you are applying and that you need assistance with

your application.

Page 2

PART IV: Certifying Statement

Under penalties of perjury, I declare that I have examined this application, that the answers appearing herein are true and correct to the best of my knowl-

edge and belief, and that I am legally authorized to sign for this agency.

I UNDERSTAND THAT FEES ARE NOT REFUNDABLE. My signature above authorizes the Department of Financial and Professional Regulation to

reduce the amount of this check if the amount submitted is not correct. I understand this will be done only if the amount submitted is greater than the re-

quested fee thereunder, but in no event shall such reduction be made in an amount greater than $50.

PART I: Application Category Information

C. FEE

$40

B. PROFESSION NAME

SALON/SHOP REGISTRATION

A. PROFESSION CODE:

189

D. CHANGE OF OWNERSHIP

If this application is for a change of ownership, check box and indicate salon/shop registration

number of previous owner.

IL486-1776 8/16 (BC)

Date Signature of Owner

IMPORTANT NOTICE: Completion of this form is necessary for consideration for licensure

under 225 ILCS 410 et. seq. (Illinois Compiled Statutes). Disclosure of this information is

VOLUNTARY. However, failure to comply may result in this form not being processed.

Each registration shall expire on November 30 of even-numbered years.

FOR OFFICIAL USE ONLY

APPLICATION FOR A

SALON/SHOP REGISTRATION

Name(s) and license number(s) of Sole Proprietor, Chief Executive Ofﬁ cer, Manager, or Managing Partner holding a license in any profession

regulated under the Illinois Barber, Cosmetology, Esthetics, Hair Braiding, and Nail Technology Act of 1985.

___________________________ ___________________________ ___________________________ ___________________________

189-

PART II: Salon/Shop Information

1. Name of Proprietor, Corporation, LLC or Partnership

3. Address of Proprietor, Corporation, LLC or Partnership

(street address, city, state, zip code--P.O. Box alone is not acceptable)

5. Name and Home Address of Corporate Ofﬁ cer or Business Partner who can be contacted

during regular business hours

(street address, city, state, zip code--P.O. Box alone is not acceptable)

2. FEIN or SSN of Proprietor,

Corporation, LLC or Partner-

ship

4. Telephone Number of Pro-

prietor, Corporation, LLC or

Partnership

6. Telephone Number of Corporate

Ofﬁ cer or Business Partner

6. Franchise? Yes No

1. Name of Salon/Shop

2. Address of Salon/Shop (street address, city, state, zip code--P.O. Box alone is not acceptable)

5. Location of Services

PART III: Owner Information

TYPE OF OWNERSHIP:

Sole Proprietorship Corporation LLC Partnership

3. Contact E-Mail Address (Required) 4. Telephone Number of Salon/Shop

Services provided at

address in line 2

Mobile salon/shop

Services provided at

clients premises