Application For Peddling Or Soliciting
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1APPLICATION FOR PEDDLING OR SOLICITING
APPLICANT INFORMATION
Name: ____________________________________________________________________________________________________
Home Address: ______________________________________________________________
Phone: (
) _______________
City: ______________________________ State:______ Zip Code: _____________
Fax:
(
) _______________
Local Address: (if different from home)_______________________________________________ Phone: (
) _______________
City: ______________________________ State:______ Zip Code: _____________
Fax:
(
) _______________
Physical Description:
Race: ___________
Height:_________
Weight: __________
Hair Color: ___________
Eye Color: ___________
________________________________
____________________________________________________
Date of Application
Signature
ORGANZATION INFORMATION (if applicable)
Name: ____________________________________________________________________________________________________
Business Address: ______________________________________________________________ Phone: (
) _______________
City: ______________________________ State:______ Zip Code: _____________
Fax:
(
) _______________
Email: ____________________________________________
Website: ___________________________________________
DECRIPTION OF SOLICITATION
Please describe the nature of the canvass or solicitation or a description of the purpose or causes for which the canvass or solicitation
is being made.
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
DATES AND VEHICLE INFORMATION
Days or dates of canvassing: ___________________ Routes or list of streets involved with this application: _____________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Vehicle Make: _______________
Model: ______________ Year: _________ Color: ____________ License No.:_______________
(DO NOT WRITE BELOW THIS LINE - BOROUGH USE ONLY)
Additional information required to be submitted with application or provided by borough:
□
□
□
□
Proof of registration of PA sales/use tax:
Yes
No
Proof of registration of Borough business taxes:
Yes
No
□
□
Photographs of each applicant approximately 2” x 2” in size, showing the head and shoulders:
Yes
No
□
□
□
□
Ordinance provided to applicant:
Yes
No
No-visit list provided to applicant:
Yes
No
:
Fees
$25.00 per day
$100.00 per week
$200.00 per month
$500.00 per year
Application accepted: __________________________________________________
Date: ______________
Building Code Official/Zoning Officer
PERMIT NO.:
____________
DATE ISSUED: ____________
INVOICE NO.
____________
CHECK NO.: __________
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