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
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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
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