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Secondhand Dealer/Pawnbroker Application

  1. Logo
  2. City of Middleton Secondhand Dealer/Pawnbroker Application
  3. Check all that apply*
  4. License Applicant
  5. List all owners, employees, officers, directors, and/or partners
  6. Have you been convicted of any of the following? (select all that apply)
  7. Have you been convicted of any of the following? (select all that apply)
  8. Have you been convicted of any of the following? (select all that apply)*
  9. Have you been convicted of any of the following? (select all that apply)*
  10. Attach a separate file to list any additional owners, employees, officers, directors, and/or partners, or if you prefer, you may attach the information requested above as a file upload.  Please be sure to include a copy of identification for each owner, employee, officer, director, and/or partner and to answer the conviction questions.

  11. Payment Method*

    Once you hit submit, you will be directed to the credit card processing page.  You may also mail a check to our office at 7426 Hubbard Avenue, Middleton, WI  53562.

  12. I understand that this license may be denied or revoked for fraud, misrepresentation or false statement contained in the application or for any violation of State Statutes 134.71, 943.34, or 948.63. Under Penalty of law, I swear that the information provided in this application is true and correct to the best of my knowledge. I agree to inform the Clerk within ten (10) days of any change in the information supplied in this application.
  13. By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.
  14. Leave This Blank:

  15. This field is not part of the form submission.