Amity Township Solicitation License Application Form

Amity Township Solicitation License Application Form
I hereby make application for license to peddle merchandise or solicit orders therefore in the Township of Amity, Berks County, Pennsylvania, in compliance with Ordinance No. 84, adopted September 5, 1980, as amended: I understand said license is not transferable.
Name

First NameLast Name
Business Name
Local Address

Street Address

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone number
Format: (000) 000-0000.
Social Security #:
Birthdate

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Do you have a previous Criminal Record:
If 'yes', please specify. ALL applicants must provide a background record check. This MUST be obtained via the Pennsylvania State Police Website https://epatch.state.pa.us/Home.jsp
Upload a Valid Form of ID (Driver's License) & Criminal Background Check

Cancelof
Name of Company you are Representing:
Address of Company:
Company Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Vehicle Make/Model & License Plate #
Merchandise to be sold / Services to be performed:
Length of Permit Requested
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I hereby certify that I will comply with laws of the United States, the Commonwealth of Pennsylvania and the Township of Amity and will not commit any fraud, sell any manufactured good, wares or merchandise by false or misleading statements or by wrongful weights and measures or sell any such articles as being composed of manufactured in whole or in part of materials and ingredients other that those of which said articles are actually composed or manufactured.
Should be Empty: