Type Full Name :
Sign With Hand
Insurance Policy #
Address
Name
Last Name *
Has the Applicant ever been convicted of a crime(s), disorderly person offense(s) or municipal ordinance violation(s)?
City *
Certification
Year
Phone # *
To add an attachment click 'Select files...'. NOTE: Pawn shops MUST submit a $10,000 surety bond before the application can be approved.
Make and Model
Per Middlesex Borough Ordinance, Application is hereby required that the Applicant be fingerprinted for a background investigation before any license may be issued.
Address *
Phone #
Surcharge Fee
Insurance Company
Business Name (if applicable)
Provide information for the Owner of the Vehicle
Social Security #
License Fee
Are you a veteran?
Peddler, Solicitor, Pawn Shop Application
Preferred License Delivery Method
First Name *
Has the Driver and/or Seller ever been convicted of a crime(s), disorderly person offense(s) or municipal ordinance violation(s)?
Are you the Business Owner? *
Date of Birth
The Undersigned hereby makes application for a license to carry on the business of PEDDLER OR SOLICITOR
Email *
You will NOT receive a license without fingerprints and approval. NOTE: License must be renewed by June 1st every year.
Business Information
Borough of
Middlesex
Name
Color
Business Address
Applicant Signature *
Drivers License #
How do you intend to pay? Note: There is a 3% surcharge if paying by Credit Card and a $.25 fee if by eCheck. *
ZIP *
Name
Pawn Shop? *
If you answered "Yes" to any of the above, describe the conviction(s) and provide date(s)
Applicant Information
Vehicle Information
Provide information for the Driver of the Vehicle
Attachments
Are you a US Citizen?
Address
License Plate #
If "No", provide the Business Owner's Information
1200 Mountain Ave
Middlesex, NJ 08846
(732) 356-7400
www.middlesexboro-nj.gov
Address
Has the Business Owner ever been convicted of a crime(s), disorderly person offense(s) or municipal ordinance violation(s)?
Total Fee
Phone #
Application Fee
For Peddler/Solicitors: Describe the Nature of Goods to be Sold
State *