Upper Allen Township Transient Retail Business License Application

Transient Retail Business License Application

Upper Allen Township
Fees: 1 Day per person- $20.00 / 1 Week per person- $75.00

Fees are subject to change at any time by Resolution from the Board of Commissioners.

Applicant Information
Applicant Name*

First NameMiddle NameLast Name
Age*
Birth date*

MonthDayYear
Date
Local Address (Motel/Hotel)*

Street Address

Street Address Line 2

CityState

Zip Code
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
Phone Number*
Prior Arrests*
This verification is made subject to the penalties of Section 4904 of the Crimes Code (18 Pa.C.S. 4904) relating to unsworn falsification to authorities. If none, put N/A.

Authorization
By submitting this application, I verify that the facts set forth in this application are true and correct to the best of my knowledge and belief. This verification is made subject to the penalties of Section 4904 of the Crimes Code (18 Pa.C.S. 4904) relating to unsworn falsification to authorities.
Signature*

Clear
Date

MonthDayYear
Date