APPLICATION FOR LICENSE FOR ITINERANT VENDOR,
PEDDLER, SOLICITOR, CANVASSER & ORDER TAKER

THIS IS NOT A LICENSE

1.  Full Name________________________     Date of Birth: _________________________
     Sex ______   Height _______Weight ______ Color Eyes ___________ Hair __________
    License No. ____________________________________________________________
    Permanent Home Address__________________________________________________
    Local Address __________________________________________________________

2.  Briefly describe the nature of your business & goods to be sold: ____________________
     _____________________________________________________________________

3.  If you are employed by someone, insert the name and address of your employer: ________
     _____________________________________________________________________

4.  How long do you wish to conduct business in Cameron? _________________________
     Indicate your source of supply of goods or property to be sold. ____________________
     _____________________________________________________________________
     Where are these goods located? ____________________________________________
     How do you intend to make delivery? ________________________________________

5.  Give names, addresses, & telephone numbers of two property owners in Clinton or DeKalb
     County who will certify as to your good character and business responsibility or other
     references described in Section 15-4 (8).
     1.  ____________________________________________________________________
     2. ____________________________________________________________________

6.  Have you ever been convicted of any crime, other than minor traffic violations? If so, give
     particulars: ____________________________________________________________
     _____________________________________________________________________

7.  Give dates of operation and the last three cities in which you operated:
     1. ___________________________________________________________________
     2. ___________________________________________________________________
     3. ___________________________________________________________________

8.  Attach hereto a 2" X 2" full front photograph of yourself showing head and shoulders
     in a clear distinguishing manner.

9.  I agree if a license is issued, that I will honor all "No Peddler" or "No Solicitation" sign;
     I further agree that I will promptly leave any private premises upon the request of the
     occupant; and I further agree not to call at any household after 9:30 p.m. or prior to
     7:30 a.m., local time. I understand that material misrepresentations in this application or
     violation of any  of the agreements herein contained will be grounds for immediate
     revocation of this license.
                                       ____________________________________
                                        Applicant

INSTRUCTION FOR OFFICE PERSONNEL

1.  This license is required by Ordinance-Chapter 15, Cameron City Code.
2.  There is a $2.00 investigation fee charge payable upon receipt of this application
     form filled out.
3.  Upon approval of the license there is a license fee charge as follows:
     Full Year - $10.00