Commercial Canvass Registration Form

City of Belvidere

401 Whitney Blvd., Belvidere, IL 61008 (815)544-2612
CHARITABLE SOLICITATION AND COMMERCIAL CANVASS MERCHANDISING REGISTRATION FORM
Name of Organization*
Address of Organization *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number of Organization *
Please enter a valid phone number.
List of Officers*
Name of Solicitation Chairman*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Nature of Solicitation *
Funds Used For*
Names of three most recent municipalities where applicant has solicited door to door*
Full Names of Solicitors *
Please Upload Driver's License of Solicitors

Cancelof
In consideration of the grant of permit, the above named applicant agrees that the act of soliciting within public streets and alleys is a dangerous activity. The above named organization agrees to hold harmless, defend and indemnify the City of Belvidere from any and all claims, actions, suits and damages arising out of, or in any way related to, the organization's solicitation activities.*

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Please Note: Applications may take 1 - 2 weeks to process as background checks are completed on each solicitor.

Payment of $220.00 is required in advance.

If paying by credit card click on the "Submit and Continue to Payment" button below and fill in your credit card information. Please note there is a service charge for using a credit card.

If paying by Check or Money Order please click the "Submit and Continue to Payment" button below and remit payment of $220.00 to:

CITY OF BELVIDERE

ATTEN: CITY CLERK

401 WHITNEY BLVD.

BELVIDERE IL 61008
Should be Empty:

City of Belvidere

CHARITABLE SOLICITATION AND COMMERCIAL CANVASS MERCHANDISING REGISTRATION FORM