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

THIS IS NOT A LICENSE

1.  Full Name: 							  Date of Birth: 					
	
Sex:  Male  Female		Height: 		  Weight: 	    Eye Color 		  Hair color 		

Driver’s License Number: 						 State of Issue: 					

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 employers: 					

														

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 “Nod Peddler” or “No Solicitation” signs;  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 Signature: 						  Date: 						

INSTRUCTIONS FOR OFFICER PERSONNEL:  1) This license is required by Ordinance – Chapter 15, Cameron City Code. 2) There is a $2 investigation fee charge payable upon receipt of this completed application.  3) Upon approval of the license, there is a license fee charge as follows:  Full Year $10