NAME
OF COMPANY
OR ORGANIZATION ______________________________________________________________________________________
ADDRESS______________________
CITY______________ STATE________
ZIP ________
DL#
____________________________________________DATE OF BIRTH ___________________
DESCRIPTION OF BUSINESS AND GOODS TO BE SOLD_____________________________
_____________________________________________________________________________________
WHERE GOODS ARE MANUFACTURED OR PRODUCED _____________________________
______________________________________________________________________________________
PROPOSED METHOD OF DELIVERY_________________________________________________
_____________________________________________________________________________________
IF GOODS ARE TO
BE SOLD AT SPECIFIC LOCATIONS, PLEASE LIST PROPOSED LOCATION(S)
_____________________________________________________________________________________
NAME
OF OWNER OF PROPOSED PREMISES ________________________________________
DATES
OF ACTIVITIES _______________ HOURS
OF OPERATION_____________________
HAVE YOU EVER BEEN
CONVICTED OF ANY CRIME, MISDEMEANOR OR VIOLATION OF ANY MUNICIPAL
ORDINANCE?
______________________________________________________________________________________
IF SO, EXPLAIN
___________________________________________________________________________________
APPLICATION
SHOULD ALSO INCLUDE THE
FOLLOWING:
DIAGRAM SHOWING THE LOCATION OF EACH CONCESSION ON THE PROPOSED PREMISES
SPECIFICATIONS
FOR ALL
ELECTRICAL SOURCES
TYPE
AND
LOCATION OF AVAILABLE SANITARY FACILITIES
WRITTEN
PERMISSION FROM PROPERTY OWNER
IF
ADDITIONAL PERSONNEL IS TO BE USED FOR SOLICITING/PEDDLING, YOU MUST
PROVIDE FULL NAME, DATE OF BIRTH AND DRIVER'S LICENSE # OF
EACH PERSON
___________________________________________________________
SIGNATURE
OF APPLICANT
DATE