CITY OF YUKON, OKLAHOMA
SOLICITOR PERMIT APPLICATION
Name: ________________________________________________________________________
Last First Middle
Permanent Home Address: ___________________________City,StateZip_________________
Cell Phone #:______________Birthdate:_____________ Social Security #:________________
Driver License Number and State:___________________________________________________
Height:__________ Weight:__________ Hair Color:____________ Eye Color:______________
Aliases:_______________________________________________________________________
Name and permanent address of firm that you represent:_________________________________
Name
Address:__________________________________City, State,Zip:_________________________________
Name and Phone Number of direct supervisor or local contact:_______________________________
Name
Phone Number:__________________________________Title:___________________________________
Description of merchandise or services offered:_______________________________________
Is any money received before delivery of product?_____________________________________
Business conducted door to door? Yes______ No_______ If no, what is the temporary address
where business will be conducted?_________________________________________________
Motor vehicle used while soliciting: Make_______ Model________Year_________Color______
License Plate___________State_______Vehicle registered to: ____________________________
Are you a U.S. citizen?___________ Place of Birth:___________________________________
Have you ever been convicted of a crime?_______If yes, give date__________ State__________
Charge:________________________________________________________________________
List the last three cities where you have done business:________________________________
Fees: $50.00 for one day; $300.00 for one week; or $1000.00 for one year
I declare the above statements are true and correct to the best of my knowledge.
Applicant’s Signature___________________________________Date_______________
No