Temporary Business License Application Form - City Of Wheat Ridge Page 3
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5CITY OF WHEAT RIDGE
7500 W. 29th Ave., Wheat Ridge, CO 80033
TEMPORARY BUSINESS LICENSE APPLICATION
Official use:
Applicant's Name
Temporary Sales/Peddler
Business Name:
Deposit
$
100.00
Business Address:
Lic Fee
$
20.00
App Fee
$
5.00
Local Address:
$
100.00
Site Cleanup
Business Phone :
Home Phone:
Personal:
Sex
:
Male
Female
Hair color:
Weight
(circle one)
Height
Date of birth:
Eye color:
TOTAL DUE
Solicitor
Description of Product to be sold
% of funds
Proposed Method of Sale:
collected to be directed to
Dates License Effective (90 day maximum)
From
to
charitable organization.
Vehicle Description:
Make
Model
Year
Color
License #
State
Name/Address/Birth Date of all agents under this license:
Zoning
Zoned
Approved by:
Date
Site Insp by:
Have any agents under this license been convicted of any crime, misdemeanor, or municipal violation?
Date
(circle one)
Yes
No
Notes:
Is any agent under this license presently on parole or probation?
(circle one)
Yes
No
If "yes" to either section please specify:
(if needed continue on back of form)
I agree to comply with all of the terms, provisions and conditions of the City of Wheat Ridge Tax Code for Temporary Businesses:
Signature:
Title
Date
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