Office of City Clerk
215 S. Broadway, Louisburg, KS 66053
913-837-5371 · louisburgkansas.gov
Application for Solicitor’s Permit
Date: _____________
Applicant Name: ____________________________________________________________________________________
Applicant Address: ___________________________________________________________________________________
Driver’s License #: _____________________________________ Expiration: _____________________________________
Date of Birth: _______________________ Sex: _________ Height: _________ Weight: _________ Hair Color: _________
Make & Model of Vehicle: ____________________________________________________Tag #: ___________________
Business Applicant is Representing: _____________________________________________________________________
Type of Business: ____________________________________________________________________________________
Name of Business Contact: __________________________________ Sales Tax ID #: ______________________________
Length of time you plan to be in Louisburg: _______________________________________________________________
Have you, the applicant, been convicted of any crime, misdemeanor (other than minor traffic violations) or violate of any
municipal law regulating peddlers, solicitors or canvassers? Yes / No
If yes, give city and state where conviction occurred, nature of offense and punishment assessed:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Solicitation shall be conducted between 8 AM and 8 PM only.
Applicant needs to present written authorization from employer authorizing he/she to solicit said product(s).
Applicant needs to supply the City with a photograph taken within 90 days prior to the date of making application. The
picture should be at least two (2) inches by two (2 inches) showing the head and shoulders of applicant or in lieu of a
picture, fingerprints may be taken by the Chief of Police and filed with application.
There is an application and investigation charge of $25 payable when the application is completed and $10 per day
charge for solicitation.
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