Solicitation License Request

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Name*
First Last
Business Phone*
Address*
Street Address City State ZIP Code
Driver's License #*
Social Security #*
IBT #*
Phone*
Fax
Cell*
Emergency Phone*
Email*
Years at above residence*
Former residence if less than 3 years
Type Of Solicitation*
Length of time requested for permit*
Organization/Employer*
Organization/Employer Phone*
Organization/Employer Address*
Street Address City State ZIP Code
How long?*
Have you filed for a solicitation permit in the past?*
- Yes
- No
When?*
Have you had a solicitation permit denied/revoked?*
- Yes
- No
When?*
Explain*
Have you ever been convicted of a felony?*
- Yes
- No
If yes, provide dates and details*
I understand that approval for a solicitation permit is contingent upon my submittal to fingerprinting by the police department. The Chief Of Police will make final determination. I further understand that I must wear the solicitation badge (Deposit - $5) at all times I am in said village.I will not solicit at homes displaying a 'No Solicitors Invited' decal. I swear that the information provided above is true. Fraudulent claims will be grounds for revocation of solicitation privileges.
Signature*
Type full name
Date*