Fillable City of Piedmont Itinerant Vendor Application (CITY OF PIEDMONT)

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City of Piedmont Itinerant Vendor Application (CITY OF PIEDMONT)

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The City of Piedmont Itinerant Vendor Application (CITY OF PIEDMONT) form is 2 pages long and contains:

  • 1 signature
  • 8 check-boxes
  • 92 other fields

Country of origin: US
File type: PDF

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City of Piedmont
Itinerant Vendor Application
City of Piedmont
314 Edmond Rd NW
Phone: (405) 373-2621
P.O. Box 240
Fax: (405) 373-3243
Piedmont, OK 73078
Date: __________________________________________ Expires (1 Year): _________________________________
Company Name: ____________________________________________________________________________________
Company Address: __________________________________________________________________________________
Owner’s Name: _____________________________________________________________________________________
Office Number: __________________________________ Other Number: __________________________________
Area Manager: __________________________________ Phone Number: _________________________________
Product Selling: __________________________________ State Tax Number: _______________________________
Proposed Area of Soliciting: ___________________________________________________________________________
Required Information:
□ $150.00 Permit Fee for Company
□ $25.00 Permit Fee for Each Individual
□ $500.00 Bond for Each Individual
□ Valid City of Piedmont Business License (if selling goods)
□ Copy of Each Individual’s Driver’s License
□ Proof of Auto Insurance on Each Vehicle
□ Proof of Liability Insurance
□ OSBI Fingerprint and Name Based Background Check on Each Individual
(OSBI Contact Number is (405) 848-6724)
Vehicle Information:
Tag #
State
Exp. Date
Year
Make
Model
Color
Reg. Owner
Individual Information:
Name
Home Address
City
State
Zip Code
By signing below, I agree that all of the above information is correct and that I agree to have all workers and vehicles will
show identification and proof of City of Piedmont itinerant vendor license.
Printed Name: ____________________________________________________________________________
Signature: __________________________________________________________________________________ Date: ____________________________________________
☐
All required information is submitted?
☐
Does each individual pass the background check?
☐
Paid
☐
Unpaid
Amount: $__________________________________
Receipt Number: __________________________
______________________________________________
Date
______________________________________________
Community Development
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City of Piedmont Itinerant Vendor Application (CITY OF PIEDMONT)

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Completed 14 July 2020

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