215 S. Broadway, Louisburg, KS 66053
913-837-5371 · louisburgkansas.gov
Date: ______________ Application Fee: $25
I hereby give consent to a background search. A background search may include, but not be limited to, a criminal history
inquiry, employment records, credit records and other pertinent information. I understand that I must provide my full
name, date of birth, driver’s license number and a copy of the license, and any alias or other name(s) by which I have
been known. I understand this search will be conducted prior to the issuance of a vendor/solicitor’s permit.
Applicant Information: (Please print)
Name: ________________________________________ Home address: __________________ State: ____ ZIP: ________
Primary Phone: __________________Date of Birth: ___________ Driver’s License #: _____________ State Issued: _____
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 a weapon, theft, fraud or sexual misconduct? Yes or No (Circle one) If you answered yes, give details
on reverse of this page; include charges, dates and places of conviction and whether you are currently on probation,
parole or any other form of supervision.
Vehicle Information:
Year: ___________ Make: _______________________ Model: ______________________ Color: ___________________
Plate No. _____________________________________ State Issued: _______________
Owner’s Name: ______________________________ Address: _______________________________________________
Business Information:
Check the type of License applying for Food Truck Other: ________________
· All vendors must be located on a commercial property lot and have permission of the lot owner.
· Vendors must provide address and contact information for those commercial locations in which they plan to operate.
· Food vendors must provide a copy of the Kansas Food Establishment License.
Nature of Business and/or goods to be sold: ______________________________________________________________
Company name: ____________________________________ Primary Phone: ___________________________________
Address: _______________________________________City: _____________________ State: ________ ZIP: _________
How long have you been employed or engaged in the business: _______________ KS Sales Tax # ___________________
Commercial lot location you plan to use: ________________________________________________________________
Address/Contact of property owner: ____________________________________________________________________
I, Employer of the above business do hereby authorize the applicant to represent the employer in conducting
__________________________________________ _______________________________________
Business Owner (please print) Signature
___________________________________________ _______________________________________
Signature of Applicant Date
Office Use Only:
Permit # _______________ Approved: _______________ Expires: Dec. 31, 20____
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