APPLICATION FOR PERMIT TO SOLICIT, PEDDLE OR VEND
TOWN OF OLD SAYBROOK, CONNECTICUT
DATE:________________
NAME: ____________________________________ SOCIAL SECURITY # ___________
ADDRESS: _________________________________CITY_______________STATE_____ZIP_____
PHONE NUMBER: ________________________ EMAIL: _________________________________
COMPANY: ________________________________ PHONE NUMBER: _____________________
ADDRESS: _________________________________CITY_______________STATE_____ZIP_____
PRODUCT/MERCHANDISE: _________________________________________________________
DATE(S) DESIRED: _______________________
VEHICLE DESCRIPTION: ____________________ LICENSE PLATE # ___________ EXP: _____
(Provide a copy of vehicle registration)
DRIVER’S LICENSE NUMBER:________________________STATE______(Provide a copy of driver’s license)
AGE: _______ D.O.B.: ________ SEX: ________ EYES: ________
COMPLEXION: ________ BUILD: ________ WEIGHT: ________ HAIR: ________
HAVE YOU EVER BEEN ARRESTED FOR ANY VIOLATION OF LAW? IF SO, GIVE DETAILS
AND DISPOSITION:
________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
THREE REFERENCES: (Name/Address/Telephone Number)
1.___________________________________________________________________________
2.___________________________________________________________________________
3.___________________________________________________________________________
Peddlers or vendors must not remain at one place longer than is required to make a sale. Solicitation shall be limited to the hours
between 9:00 a.m. and sunset. A copy of this application is forwarded to our local police department for review.
I HAVE REVIEWED §159 PEDDLING AND SOLICITING OF THE OLD SAYBROOK TOWN CODE AND
ACCEPT THE CONDITIONS SET FORTH. I HEREBY STATE THAT THE ABOVE INFORMATION IS
TRUE TO THE BEST OF MY KNOWLEDGE:
SIGNATURE: ______________________
PRINT NAME
OFFICE USE ONLY:
# OF DAYS: _________ # OF MONTHS: _________ CHECK NO. ________ CASH: ________
DENIED: [if denied, reason] _________________________________________________________________
The First Selectman under §159-6 Issuance of registration certificate of The Code of the Town of Old Saybrook shall have the right to
issue or deny the application certificate not less than 24 hours but no more than 72 hours after the submission of the application.
ISSUING OFFICER:____________________________
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