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					                                                                                  Application for Permit

                                                                                Peddler and Solicitation

Applicant’s Name ___________________________________Date of Birth ______/___/____ Age_____
                                                                             Month / Day / Year

Date of Application _______________________ Applicant’s Local Telephone Number____________________

Applicant’s Physical Description__________________________________________________________

____________________________________________________________________________________

Applicant’s Permanent Home Address _____________________________________________________

____________________________________________________________________________________

Applicant’s Local Address _______________________________________________________________

____________________________________________________________________________________

Company/Organization Name ___________________________________________________________

Company/Organization’s Address_________________________________________________________

____________________________________________________________________________________

Nature of Business or Activity ___________________________________________________________

Describe Goods, Services or Wares to be Sold _______________________________________________

____________________________________________________________________________________

Days and Dates of Peddling, Soliciting, Canvassing (Valid for 90 days from issuance - Monday through
Saturday- 9am to 9 pm) _________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Have you ever been convicted of a crime, misdemeanor or disorderly persons offense? ________________

       If yes, give details _______________________________________________________________

       ______________________________________________________________________________


                                          Winterville Police Department
                                       PO Box 1459 Winterville, NC 28590
                                       (252) 756-1105 - Fax (252) 756-3458
                                                   Page 1 of 2
                                                                                                 Application for Permit

                                                                                               Peddler and Solicitation


Vehicle: Make (ex. Honda, Ford, etc.)_____________ Model (ex. Accord, Explorer) _________________

            Year ____________ Color __________________________

List current peddling, soliciting or canvassing permits received from other municipalities_______________
____________________________________________________________________________________

____________________________________________________________________________________

Have you ever been denied a peddling, soliciting or canvassing permit during the past 12 months? _______


________________________________________________                                          ________________________
Signature of Applicant                                                                    Date

-----------------------------------------------------------------------------------------------------------------------------
ATTACH THE FOLLOWING TO THIS APPLICATION FOR PERMIT:

      1)          Recent photograph of applicant, at least 3 x 5 inches in size showing head and shoulders of
                  applicant in a clear and distinguishing manner

      2)          Copy of applicant’s driver’s license

      3)          Copy of vehicle registration

      4)          Copy of vehicle insurance certificate

      5)          Payment (This application fee is non-refundable.)
                  If on foot - $10.00 per permit
                  If by vehicle - $25.00 per permit
                  (Application will not be considered complete without these items being attached.)

      6)          If approved, some permits may require you to apply to Town Hall for a Privilege License.

Please note that your signature above grants the Town of Winterville authorization to conduct a criminal
background investigation and a driver license record check.


Police Department (Use Only)

_______ Approval                    ______ Denial

                                                    Winterville Police Department
                                                 PO Box 1459 Winterville, NC 28590
                                                 (252) 756-1105 - Fax (252) 756-3458
                                                              Page 2 of 2

				
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posted:10/20/2011
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