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2. Village of Elm Grove Cigarette, Tobacco, and Vapor Products License Application

   You are applying for the July 1, 2026 to June 30, 2027 Cigarette, Tobacco, and Vapor Products License. The application and forms from the DOR must be completed in order to be approved. Licenses will be EMAILED TO THE APPLICANTS once approved. No licenses will be sent in the mail. The license must be placed in a visible area.

3. APPLICATIONS DUE April 15th

5. Use the following link to pay via credit card: https://app.heygov.com/elmgrovewi.org/quick-pay
   PLEASE NOTE what and who the fees paid pertain to.Or submit fee to the Village Clerks office via check. Please make payable to The Village of Elm Grove.

7. Legal Business Name *
8. Business Trade Name *
10. Premise Contact Name *
11. Premise Contact Phone Number *
13. Email the License to...*
15. I will be selling...*

    1. Cigarettes
    2. Tobacco Products
    3. Electronic Vaping Devices
16. I will be selling these products...*

    1. Over the Counter
    2. Vending Machine
18. Premises Description*

    Describe the building or buildings where Cigarettes, Tobacco Products, and Electronic Vaping Devices are sold, stored, and related records are kept. Describe all rooms within the building, including living quarters. 

20. Agent Information
22. Agent Name*
23. Agent Phone Number*
25. Agent Email Address*
27. Additional Agents Name, Phone Number and Email
29. Forms
31. CTV-100 Form
    Download CTV-100 Cigarette, Tobacco, and Electronic Vaping Device Retail License Form
33. Upload CTV-100 Form*
35. CTV-101 Form
    Download CTV-101 Cigarette, Tobacco, and Electronic Vaping Device - Individual Questionnaire
37. Upload CTV-101 Form*
39. CTV-102 Form
    Download CTV-102 Cigarette, Tobacco, and Electronic Vaping Device Appointment of Agent Form
41. Upload CTV-102 Form*
43. Upload Wisconsin Sellers Permit *
45. Background Check Fee is Required for all Agents and Officers of $10*
    -- Select One --$10 - 1 Agent or Officer$20 - 2 Agents or Officers$30 - 3 Agents or Officers$40 - 4 Agents or Officers$50 - 5 Agents or OfficersSame as Alcohol License application

    Include the Background Check Fee with your Application. *IF your Agents are the same as the Alcohol licensing form you do not need to submit payment for a background check again and select the dropdown "Same as Alcohol License Application"

46. Include the Publication Fee

    If you have already submitted an Alcohol License Form with a Publication Fee included and you're also submitting for a Cigarette License your publication fee is $25

    If you are ONLY completing the Cigarette License application your publication fee is $40. 

48. CTV Application $100

    Due by June 15th. You may submit the full fee with your application.

50. Acknowledgement*

    1. I acknowledge the following statement.

    By submitting this document, you acknowledge the following: I understand I must pay the license fee in full if I wish to have the license issued to my business. I understand I can have no outstanding debt with the Village of Elm Grove and possibly Waukesha County. I understand the agent information is sent for a criminal background check, a legal notice for the license is placed in the paper, and the Board of Trustees must approve the license application before the Clerk can issue me my license. I understand I cannot sell my Cigarette license to another person or entity, that they must apply through the Village and I either relinquish/surrender my license within the year or I do not apply for a renewal of the license at the end of the license period.

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52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field