{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
City
ZIP
Phone #
Name
State
City
Address
License Duration
Phone #
Address
Social Security #
Are you a veteran?
License Term
Phone #
Full Name
Email
Firm Being Represented
Firm Name
Date of Birth
Email
City
ZIP
Applicant Details
Temporary Address
ZIP
Are you a US Citizen?
State
State
{[PNAME]}
  • Business & Vehicle Information
  • Fees, Attachments, & Certifications
Peddler/Solicitors: Give a detailed description of Goods to be Sold
Insurance Policy #
Address
Name
Has the Applicant ever been convicted of a crime(s), disorderly person offense(s) or municipal ordinance violation(s)?
Year
Make and Model
Phone #
Insurance Company
Business Name (if applicable)
Provide information for the Owner of the Vehicle
Email
Has the Driver and/or Seller ever been convicted of a crime(s), disorderly person offense(s) or municipal ordinance violation(s)?
Applicant is Business Owner?
The Undersigned hereby makes application for a license to carry on the business of PEDDLER OR SOLICITOR
Business Information
Name
Color
Full Address
Drivers License #
Business Owner Full Name
If you answered "Yes" to any of the above, describe the conviction(s) and provide date(s)
Vehicle Information
Provide information for the Driver of the Vehicle
License Plate #
Address
Has the Business Owner ever been convicted of a crime(s), disorderly person offense(s) or municipal ordinance violation(s)?
Phone #
For Peddler/Solicitors: Choose the type of Goods to be Sold
Type Full Name :
Sign With Hand
Certification
If applicant is an agent, employee or representative, attach a letter from the person or organization for whom applicant works, authorizing applicant to act as its agent, employee or representing and assuming responsibility for each individual applicant’s conduct.
By signing below, I the owner certify that all of the information provided in this application is true and accurate.
Driver's License & DD214 Card / ID (only veterans exempt)
License Fee
Preferred Delivery Method
Applicant shall also be required to produce valid photo identification (such as driver’s license or passport), to be photocopied and attached to the application.
Applicant Signature
Attachments
Application Fee
Application Type Fee
Veteran’s Exempt $0
30 Day License $20
Over 30 Days License $100