City of Roswell, P.O. Drawer 1838, Roswell, NM 88202
Attn: Business License Clerk
VEND
OR MERCHANT APPLICATION
Present this completed application to Roswell Police Department, 128 W. Second St. for a background check
and fingerprinting. Bring this completed application to the City Licensing Clerk in the Code Enforcement
Office, 421 N. Richardson, telephone (575) 637-6208, for issuance of the permit.
For fee information please contact number above
Seven (7) days advance notice required.
PLEASE PRINT
Full Name: _________________________________________________ Telephone No.: ( ) ___________________
Permanent Street Address: ____________________________________________________________________________
City: _____________________ State: ________ Zip: ____________ SSN: ______-_____-______ Sex: F M
(circle one)
Driver=s Lic. No.: ___________________________ State: _________________ Date of Birth: ____________________
Place of Birth: ________________________________________________________ Height: ________ Weight: ______
Hair Color: _______________________ Eye Color: ___________________ Complexion: _______________________
Scars or Identifying Marks (description): ________________________________________________________________
__________________________________________________________________________________________________
Roswell Address (Motel): _____________________________________________ Phone No.: _____________________
Vehicle Description: Year: ___________ Make & Model: ________________________________________________
Color: ______________ License No.: ______________________ State of Issue: ______________________________
Name of Employer: _______________________________________________________ No.Years Employed: ________
Address: _____________________________________ City:____________________ State:________ Zip:____________
Telephone No. ( ) _________________ Residence Last 12 Months:_______________________________________
New Mexico State Tax ID No. (CRS Tax Id #): __________________________________________________________
Type of Goods/Merchandise/Services to be sold: ________________________________________________________
Selling dates: ______________________________________________________________________________________
Selling Location: __________________________________________________________________________________
***Have you ever been convicted of an offense involving moral turpitude, misdemeanor or felony? Yes____ No____
(Moral turpitude of conduct which is contrary to the customary rules or rights and duties between persons or a person and
a society, and would include but not limited to, such conduct as assault, battery, larceny, shoplifting, sexual offenses,
contributing to the delinquency of a minor, theft, fraud, and similar types of conduct). If yes, explain on the reverse of
this form.
________________________________
________________________________________________
VENDOR/MERCHANT SIGNATURE Date
Zoning Department Approval for food vendors only (must submit property owner’s permission in writing).
Planni
ng & Zoning Official: ________________________________________ Date:
___________________________
NCIC RECORDS CHECK____________________________ ****PLEASE LIST ARREST HISTORY ON REVERSE
___
___________________________________________________ __________________________________
POLICE DEPARTMENT SIGNATURE Date
