2. Name of Applicant*
3. Phone Number*
5. Home Street Address*
7. City*
8. State*
9. Zip*
11. Driver's License Number
12. State
14. Have you ever been convicted, even if expunged, of a felony or of any offense involving violence or threats of violence, possession or use of weapons, theft, fraud or sexual misconduct? *

    1. Yes
    2. No
16. If yes, please include charges, dates and places of convictions and whether you are currently on probation, parole or any other for of supervision.
18. Company or DBA Name*
19. Company Phone Number*
21. Company Address*
23. City*
24. State*
25. Zip*
27. How long have you been employed by this company or used this company name?*
29. Vehicle Used (if any):
31. Year/Color
32. License Plate Number
33. Is Company name or logo displayed on vehicle?

    1. Yes
    2. No
37. I, the undersigned applicant, agree to the following provisions:
39. I understand and agree that if a permit is granted, it will not be used or represented in any way as an endorsement by the City of Goddard or by any department or officer of the City.*

    1. I agree
    2. I disagree
41. I have not been convicted of violation of any law or ordinance regulating selling, soliciting or peddling within the past five years.*

    1. True
    2. False
43. I have never had a vendor or solicitation permit or registration revoked or suspended under the ordinances of the City of Goddard or any oher city. *

    1. True
    2. False
45. I understand that it is unlawful to sell, solicit or peddle prior to 8:00 a.m., or after 9:00 p.m. on any day of the week.*

    1. Yes
    2. No
47. I understand that it is unlawful to ring a bell, knock on a door, or otherwise attempt to gain admittance for the purpose of selling, soliciting or peddling at a residence or dwelling at which a sign bearing the words "no solicitors" or "no trespassers" or similar words are affixed or exposed to public view. *

    1. Yes
    2. No
49. I understand that it is unlawful to engage in selling, soliciting or peddling on any premises or dwelling after having been asked to leave the premises or dwelling. *

    1. Yes
    2. No
51. I understand that it is unlawful to sell or solicit or peddle without carrying a valid permit and exhibiting it upon request of any resident or officer of the City of Goddard. *

    1. Yes
    2. No
53. I certify, under penalty, that all of the information contained in this application is true and correct to the best of my knowledge and belief.*

    1. Yes
    2. No
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55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

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