Transient, Solicitor, Peddler Vendor Permits

2. Name of Business or Organization*
4. Sales Tax Number*
6. Owner First Name*
7. Owner Last Name*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
16. Email Address*
18. Description of Business and Goods to be Sold*
20. Dates of Business or Solicitations *
    Dates of Business or Solicitations Start Date

    —

    Dates of Business or Solicitations End Date
22. Representatives Making Sales or Solicitations
24. Valid Photo Identification must be Uploaded for ALL Representatives**
26. Proof of affiliation to company for ALL representatives.*
28. First Name*
29. Last Name*
31. Address*
33. City*
34. State*
35. Zip Code*
37. Description of Vehicle: Color/Make/Model *
39. License Plate Number*
40. State Issued*
41. Owner of Vehicle*
43. First Name
44. Last Name
46. Address
48. City
49. State
50. Zip Code
52. Description of Vehicle: Color/Make/Model
54. License Plate Number
55. State Issued
56. Owner of Vehicle
58. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
60. Electronic Signature*
61. Completion Date*
    Completion Date
Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit Submit and Print

* indicates a required field