PEDDLERS, SOLICITORS & OTHER DIRECT SELLERS REGISTRATION FORM

PEDDLERS, SOLICITORS & OTHER DIRECT SELLERS REGISTRATION FORM
Name*
Address*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name of Person/Company that the applicant represents*
Nature of business to be conducted and a brief description of the goods offered and any services offered*
Proposed Method of Delivery of Goods, if applicable*
Make model and license number of any vehicle to be used by applicant in the conduct of his business*
Signature*
Date*

MonthDayYear
Date
Approved by
Date

MonthDayYear
Date
Permit No
Issue Date

MonthDayYear
Date
Expiration Date

MonthDayYear
Date
Each applicant shall submit for examination: A driver's license or some other proof of identity as may be reasonably required;

A state certificate of examination and approval from the sealer of weights and measures, where the applicant's business requires use of weighing and measuring devices approved by state authorities;

A state health officer's certificate, where the applicant's business involves the handling of food or clothing and is required to be certified under state law; such certificate to state that applicant is apparently free from any contagious or infectious disease, dated not more than 90 days prior to the date the application for license is made;

In addition a signed statement containing: The last three previous municipalities where applicant conducted similar business;

Place where applicant can be contacted for at least seven days after leaving the Borough;

Statement as to whether applicant has been convicted of any crime or ordinance violation related to applicant's transient merchant business within the last five years; the nature of the offense and the place of conviction.
Should be Empty: