BBL Refund Request Application

The purpose of this form is to initiate a financial review of funds paid to the Business Licensing Division at the Department of Licensing and Consumer Protection to be considered for a refund from the Office of the Chief Financial Officer. Refund requests are considered in cases of excess payment, duplicate payment and/or erroneous filing. Please note that application fee and the associated technology fee are non-refundable.In order to initiate a refund request, the following documentation is required:Refund Request ApplicationCancellation Letter (if applicable)Recipient’s Name, FEIN and Mailing AddressProof of All Associated Payment(s):Check: Front and back of cashed checkCredit Card: Receipt and first six and last four digits of credit card numberCash: Receipt of payment from Cashier's OfficeMoney Order: Money Order Receipt*Please attach all required supporting documentation to this request to avoid any delays in receiving your refund.

Basic Business License Number

Name of Licensee (Business Name as it Appears on Basic Business License)

9-Digit Tax Number (No spaces or dashes)

Reason for Refund Request

Detail the Reason for Your Refund Request

IMPORTANT: If your business is no longer operating, the license must be cancelled or the application must be withdrawn before a refund request can be considered. Please submit a BBL Cancellation Request.

Amount Requested

What method of payment was used for this transaction?

Upload Proof of Cash Payment (i.e., receipt from DLCP Cashier's Office).

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Upload Proof of Check Payment (i.e., front and back of cashed check)

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Upload Proof of Credit Card Payment (Receipt)

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Upload Proof of Money Order Payment (i.e., money order receipt and receipt from DLCP Cashier's Office)

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Please enter the first (6) six and last four (4) digits of credit card number used for transaction. (i.e., 1234-56xx-xxxx-7890)

If any additional payments are associated with this request, please select the additional method of payment.

Upload Proof of Cash Payment (i.e., receipt from DLCP Cashier's Office)

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Upload Additional Proof of Check Payment (i.e., front and back of check)

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Upload Proof of Credit Card Payment (Receipt)

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Upload Proof of Money Order Payment (i.e., money order receipt and receipt from DLCP Cashier's Office)

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Please enter the first (6) six and last four (4) digits of credit card number used for transaction. (i.e., 1234-56xx-xxxx-7890)

Upload any documents (excluding proof of payment) that support your refund request.

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Title of Requestor

Requestor's Phone Number

Requestor's Email Address

To Whom Should the Refund be Made? (i.e., Business, Inc. c/o Jane Doe)

I certify that the above statements on this application are true and complete to the best knowledge and belief. I agree to comply with all applicable laws and regulations of the District of Columbia. I/We understand that, anyone who makes a false statement on this form can be criminally prosecuted; and, if convicted, fined up to $1000, imprisoned up to 180 days, or both, under D.C. Official Code § 22-2405.

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First Name

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.

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