Solicitation Permit Application

Solicitation Permit Application

For additional information and regulations, please go to the Town of Galena 2020 Zoning Ordinance found at https://ecode360.com/GA3097/documents/Legislation#category-495718017-year-2020
Solicitor Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Driver License Number
Date of Birth

MonthDayYear
Date
Business Name
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Make, Model, Body Style, License Plate #, and VIN # of each Motor Vehicle to be used in Town:
Nature of Solicitation - Describe the merchandise to be sold/offered, nature of services, type of pamphlets/handbills to be distributed, etc.
Name all cities in which the applicant has conducted solicitation or handbill distribution in the past six (6) months:
Describe whether the applicant or business will request, accept, or receive payment for goods or services at the time of solicitation, including any deposits or advance payments prior to final delivery of goods or completion of services. If applicable, specify the amount requested or the method used to calculate such payment:
Has the applicant or business, within the ten (10) years preceding the date of this application, pled guilty to or been convicted of any felony or misdemeanor involving fraud, deceit, theft, embezzlement, burglary, larceny, fraudulent conversion, misrepresentation, or misappropriation of property?
If yes, please provide a description of each conviction or plea, including the name of the court and jurisdiction where the complaint or indictment was filed, and the date of the offense.
Has the applicant or business been the subject of any civil judgment or administrative decision within the ten (10) years preceding the date of this application involving fraud, deceit, theft, embezzlement, burglary, larceny, fraudulent conversion, misrepresentation, or misappropriation of property?
If yes, please provide a description of each conviction or plea, including the name of the court and jurisdiction where the complaint or indictment was filed, and the date of the offense.
PLEASE UPLOAD THE FOLLOWING DOCUMENTATION:
- Solicitor’s current driver’s license or other state-issued identification.
- A recent photograph of the solicitor.
- Solicitor’s emergency contact information.
- Criminal background check authorization or background check results.
- Proof of employment or authorization to act on behalf of the business for which solicitation activities will be conducted.
- Business license or registration for the company being represented.
- Vehicle registration for all vehicles used during solicitation activities.
- Proof of insurance for all vehicles to be operated within the Town.
- General liability insurance certificate, if applicable.
- Itinerary or proposed solicitation dates and locations within Town limits.
File Upload

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Additional Information/Questions
KEY INFORMATION:
- A separate permit shall be required for every individual engaged in commercial home solicitation or handbill distribution and must be presented upon request.
- A separate permit shall be required for each company or entity engaged in commercial home solicitation or handbill distribution.
- No permit shall be valid for multiple individuals, companies, or entities.
- Permits shall be valid only for the duration of the current calendar year.
- It shall be the responsibility of the applicant to update any information provided on the application if such information changes.
- Solicitation hours shall be limited to Monday through Friday between 9:00 AM and 6:00 PM and Saturday between 9:00 AM and 12:00 PM. Solicitation is prohibited on Sundays.
- Violations of the permit requirements may result in a fine of up to $5,000 per violation, as authorized by applicable Town ordinances or law.
- Solicitors shall wear visible identification and proof of permit at all times while engaging in solicitation activities.
By signing and submitting this application, the applicant affirms that they are authorized to submit this permit application on behalf of the property owner, business, or entity identified herein, and certifies that all information, statements, and materials provided in connection with this application are true, accurate, and complete to the best of their knowledge and belief. The applicant understands that any false, misleading, or incomplete information may result in denial, suspension, or revocation of the permit and may subject the applicant to any applicable penalties under Town ordinances or other applicable law.

No activity can begin until you receive an approved permit. NO EXCEPTIONS.
Signature
Date

MonthDayYear
Date
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