Peddlers & Solicitors

2. Type of Permit*

   1. 90 Days ($35)

   1. Six Months ($70)

   1. One Year ($100)

6. Business Name

8. Address1

10. Address2

12. City

13. State

14. Zip

16. Business Type

    What types of products, merchandise, or services will be sold, disposed of, or peddled? Please provide a brief description of each.

20. Applicant

22. First Name

23. Last Name

25. Address1

27. Address2

29. City

30. State

31. Zip

33. Home Phone

34. Business Phone

35. Cellular Phone

37. Age

38. Height

39. Weight

40. Race

42. Has the applicant or additional solicitors been convicted of any crime, misdemeanor, or violation of any code provision or any other ordinance of the city?

    1. Yes

    1. No

44. Offense

45. Name of Court

46. Conviction Date

48. Will applicant, upon any such sale or order, shall demand, accept, or receive payment or deposit of money in advance of final delivery?

    1. Yes

    1. No

50. I, being first duly sworn on my oath, state that I personally filled in the blanks in the above application, on oath state that the statements made herein are true and correct.*
    -- Select One --Yes, I made these statements. They are true and correct.

52. This form must be printed. It must be signed and notarized. There is a notary available at the police department.

    This form must be printed. It must be signed and notarized. There is a notary available at the police department.

54. Applicant Signature (after printing)

55. Date

57. SUBSCRIBED AND SWORN before me, (date)

    SUBSCRIBED AND SWORN before me, (date)

59. Notary Public Signature

Leave This Blank:


62. Print Only

* indicates a required field