Page 1 of 2 (Corporate/Firm revised 12/17/09)
APPLICATION FEE: $10.00
PER DAY: $25.00
EACH HELPER: $5.00
OVER 30 DAYS: $300.00
CITY
OF
ELOY
PEDDLERS/SOLICITORS/CANVASSERS/TRANSIENT M
ERC
H
A
NT
S
(CORPORATE
OR
FIRM LICENSE
A
PP
L
I
CA
TION
)
Assessors Parcel #:
State Tax ID#:
(if applicable) (if applicable)
NAME:
LEGAL ADDRESS:
BUSINESS LOCATION ADDRESS:
.
DESCRIBE NATURE OF BUSINESS:
GOODS TO BE SOLD:
EMPLOYER: NAME
ADDRESS
HOW LONG DO YOU WISH LICENSE FOR:
DESCRIPTION OF VEHICLE:
VEHICLE LICENSE NUMBER:
PHOTOGRAPH (attached)
FINGERPRINTS (attached)
COPY OF DRIVERS LICENSE (attached)
Yes No
Yes No
Yes No
COPY OF COMPANY IDENTIFICATION CARD (if applicable) Yes No
PLEASE STATE ALL CONVICTIONS OF ANY CRIME, MISDEMEANOR (EXCEPT MINOR
TRAFFIC VIOLATIONS), AND VIOLATION OF MUNICIPAL CODE LAWS, THE NATURE OF
THE OFFENSE AND PUNISHMENT OR PENALTY.
Signature of Applicant Date
click to sign
signature
click to edit
Page 2 of 2 (Corporate/Firm revised 12/17/09)
CITY OF ELOY CORPORATE OR FIRM
INFORMATION
Name of Owner/Operator:
Home Address:
City/State/Zip:
Telephone Number:
Date of Birth: Height: Weight:
Hair:
Eyes: Drivers License State of Issuance:
Driver’s License #:
Social Security #:
**PLEASE INCLUDE A COPY OF ALL AGENTS/REPRESENTATIVES WHO WILL BE OPERTAING IN
THE CITY OF ELOY INCLUDING THEIR ADDRESSES AND TELEPHONE NUMBERS.
EMERGENCY CONTACT DURING NON-BUSINESS HOURS:
Name:
Telephone #: _
Address:
City/State/Zip:
--------------------------------------------DO
NOT WRITE BELOW THIS LINE------------------------------------------
APPROVED:
DATE:
APPROVED:
DATE:
DENIED:
DATE:
DENIED:
DATE:
City of Eloy
Finance Department
628 North Main Street
Eloy, Arizona, 85131
Licensing Eligibility Requirement Form (ARS § 41-1080)
Effective October 1, 2008, a new law went into effect preventing the City from issuing a license (either new or
renewed) to an individual unless the individual has provided the City of Eloy with one of the forms of
identification listed below. If your business is incorporated, provide a certificate of good standing.
To become or remain eligible for a license, complete this form and present one of the forms of identification as
listed below to the City of Eloys Finance Department for processing. Please indicate which form is presented.
An Arizona driver license issued after 1996 or an Arizona non-operating identification
A driver license issued by a state that verifies lawful presence in the United States. (Licenses
from HI, IL, ME, MD, NM, TX, UT and WA are not acceptable.)
A birth certificate or delayed birth certificate issued in any state, territory or possession of the
United States.
A United States certificate of birth abroad.
A United States passport.
A foreign passport with a United States visa.
An I-94 form with a photograph.
An United States citizenship and immigration services employment authorization document or
refugee travel document.
A United States certificate of naturalization.
A United States certificate of citizenship.
A tribal certificate of Indian blood.
A tribal or Bureau of Indian Affairs affidavit of birth.
Corporate certificate of good standing
By my signature below, I hereby certify, under penalty of perjury, that I am legally authorized to be present in
the United States.
Full Signature of Licensee Date
click to sign
signature
click to edit
Business License Fee Schedule
Business License Description
Proposed
License Fee
General Fixed Business (that maintains a physical location in the City limits)
Other than specified below
$75
General Fixed Business (that do NOT maintain a physical location in the City
limits)
Other than specified below
$75
Daily Business Transaction License
$10
Liquor License:
Series # 6
On-sale retailers licensed to sell all spirituous liquors
$250
Series # 7
On-sale retailers licensed to sell beer and wine
$175
Series # 8
On-sale retailers licensed to sell beer
$150
Series # 9
Off-sale retailers licensed to sell all spirituous liquors
$175
Series # 10 - Off-sale retailers licensed to sell beer and wine
$150
Series # 11 - Off-sale retailers licensed to sell beer
$125
Series # 16
Restaurant retailers licensed to sell all spirituous liquor
$250
Hotel, Apartment, RV Parks, Mobile Home Parks and Rest Homes:
1-10 Units
$50
11-50 Units
$75
Over 50 Units
$100
Wholesalers, manufacturers, and providers of services without a fixed place of
business within the City limits
$75
Pawnbrokers, secondhand dealers, junk dealer or junk collector
$75
Barber Shops/Beauty Operators and owner
$50
Barber/Beauty Operators
Individual
$25
Peddlers and Transient Merchants are defined in this chapter:
Application Fee
$10
Per Day
$25
Each Helper
$5
Per Month in excess of one month
$300
Mobile Vendor
$75 plus
application
fee of $25
Promotors of entertainment, circuses, bazaars, etc., who receive a percentage
of receipts or other consideration for their services. Each such promoter shall
also obtain liability insurance of a minimum of $1 million naming the City as
insured.
$100 per
week
Animal Show
$100 a week
Circus Parade Only
$50 a day
Handbill Distributor
$10 a day
Amusement Company, such as Ferris wheel, merry go-round not part of circus
$175 a day
Wrestling/Boxing/Martial Arts Exhibition
$175 a day
Road Show, Carnival or Circus
$175 a day
Practice of Palmistry, Phrenology, Astrology, Fortune Telling, Mind Reading,
Clairvoyancy, Magic or any healing practices not licensed by the State of
Arizona or any similar calling without a fixed place of business.
$250
Yard Sale
$0
Adult Oriented Business
See Article VII
Medical Marijuana:
Annual Medical Marijuana Business License Application and
Investigation Fee
$500
Annual Medical Marijuana employee License Fee (per employee)
$250
Annual Medical Marijuana Business License Fee
$250
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