Yes No

Yes No

Yes No

With Automobile On Foot Without Wheeled Vehicle

Yes No

Yes No

Yes No

Address

Name

The Applicant *

State

City *

State

Certification

Address

Year

Phone # *

Make and Model

The applicant MUST be fingerprinted and undergo a background investigation by the Lodi Police Department.

No license will be issued until approval has been given by the Lodi Police Department.

NOTE: Licenses are only valid for one (1) year from date of issue.

Address *

Phone #

Hair Color

Provide information for the Driver of the Vehicle

Social Security #

License Fee

If activity is to be conducted using a vehicle please complete this section, otherwise continue to next section.

Is a veteran? *

Phone #

Specify the purpose(s) of the soliciting *

Weight (lbs)

Name *

The Driver of the vehicle (if applicable)

Business Information

Business Name *

Is the Applicant the Business Owner? *

Date of Birth

How will the applicant be conducting business *

Email *

Color

Background

Address

Applicant Signature *

Driver's License #

City

Activity

ZIP *

Business Owner's Name

Eye Color

If you answered "Yes" to any of the above, describe the conviction(s), provide date(s) and location

Applicant Information

Vehicle Information

Height (ft & in)

Have any of the following ever been convicted of a crime(s), disorderly person offense(s) or municipal ordinance violation(s)? *

ZIP

Age

Is a US Citizen? *

Required Documents

City

License Plate #

If "No", provide the Owner's Information below, otherwise continue to the next section.

Issuing State

The Business Owner *

Please attach the following documents. *

1. List of goods/services to be sold
2. Employment Verification Letter
3. Copy of Applicant's Driver's License

Place of Birth

Phone #

Amount Due

State *

ZIP