Application shall be made at least ten (10) days before license is issued. Two copies of a recent photograph must be submitted at time of application.

PLEASE PRINT

LICENSE APPLICATION FOR PEDDLER/SOLICITOR

Photo Submitted:_____________

Fee: $7.50 - 6 Months_____________                      $15.00 - 12 Months____________

Name:____________________________________________________ Date:_______________________

Sex: M ___ F ___ Weight:______ Height:______ Hair:_______ Eyes:__________

Home Address:________________________________________________________________________
         City:_______________________________________ State:____________ Zip:________________

Present Address:______________________________________________________________________
         City:_______________________________________ State:____________ Zip:________________

Social Security No:____________________________________________________

Residences During Previous Calendar Year (Include City/State/Zip):

Address:______________________________________________________________________________
Address:______________________________________________________________________________

Current Employer:______________________________________________________________________
List All Employers During Previous Calendar Year:
Employer:_____________________________________________________________________________
Employer:_____________________________________________________________________________

All Municipalities In Which You Have Engaged In Business Or Activity Of Peddler/Solicitor During Previous Calendar Year:
__________________________  __________________________   __________________________
__________________________  __________________________   __________________________

Nature of Business:_____________________________________________________________________
Product and/or Service:__________________________________________________________________

Description of vehicle to be used: Make: ____________________Model:__________________________
Year:__________ License No._____________ Color:______________

Signature of Applicant:__________________________________________________________________
                                                        Do not write below this line
**********************************************************************************************************************
Investigated by:________________________________________________ Date:___________________

Approved:___ Denied:___ City Administrator: __________________________________ Date:________

10/7/98                                                                            License No:__________________________