Fillable Peddlers Solicitors And Canvassers PDF (Charter Township of Waterford)

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Peddlers Solicitors And Canvassers PDF (Charter Township of Waterford)

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CHARTER TOWNSHIP OF WATERFORD
CLERK’S OFFICE
5200 Civic Center Dr. Waterford, MI 48329
Phone 248-674-6266 Fax 248-674-5455
Web Page www.waterfordmi.gov
PEDDLER LICENSE APPLICATION
Page 1 of 5
1. New Application
Complete all pages 1 through 5.
Add-On
Original Application Date _____________
One time within 30 days of the original
application date.
Renewal
Complete only page 1 if there have been no
changes since original application including but
not limited to: solicitors, iChat report, times and
locations of peddling, etc.)
_______________________________________
Signature and Date of Renewal
INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED
2. Contact Person
NAME ADDRESS
PHONE NUMBER FAX NUMBER E-MAIL ADDRESS
3. Peddler’s Parent Organization
NAME
Tax ID Number
BUSINESS STREET ADDRESS
CITY
STATE
BUSINESS PHONE
WEBSITE ADDRESS
WHEN AND WHERE PARENT ORGANIZATION WAS ESTABLISH OR INCORPORATED AND THE FORM OF ORGANIZATION
CLERK’S USE ONLY
Date Received: Non-Refundable Application Fee $50.00 and $10.00 each additional person Paid
Date Sent to Depts Police: Response from Police: License Number (if issued) ___________
Date and Location ___________________________________________________________________________________
Peddler means any person engaged in peddling for profit in the Township by traveling by foot, motor
vehicle or other conveyance from place to place, from house to house, or from street to street, or who does so
from or at a stand, motor vehicle, or trailer. Any person who offers to take orders or tentative orders and, as a
separate transaction, confirms the order or makes deliveries to purchasers as part of an transient merchant
scheme or design to evade the provisions of this Article shall be deemed a peddler. The term "peddler" shall not
include a person who conducts such activities at a social gathering within a home at the invitation of the owner or
an occupant of the home.
Revised 10/2017 Page 2 of 5
4. List all persons who propose to peddle within the Township
NAME
BUSINESS STREET ADDRESS
CITY
STATE
HOME STREET ADDRESS
CITY
STATE
BUSINESS PHONE
HOME PHONE
CELL PHONE
WEBSITE ADDRESS, IF ANY
E-MAIL ADDRESS
DRIVER’S LICENSE NUMBER
PHYSICAL DESCRIPTION
HEIGHT
WEIGHT
COLOR OF HAIR / LENGTH
EYES
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS
ARRESTING AGENCY
DATE
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS
ARRESTING AGENCY
DATE
NAME
BUSINESS STREET ADDRESS
CITY
STATE
HOME STREET ADDRESS
CITY
STATE
BUSINESS PHONE
HOME PHONE
CELL PHONE
WEBSITE ADDRESS, IF ANY
E-MAIL ADDRESS
DRIVER’S LICENSE NUMBER
PHYSICAL DESCRIPTION
HEIGHT
WEIGHT
COLOR OF HAIR / LENGTH
EYES
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS
ARRESTING AGENCY
DATE
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS
ARRESTING AGENCY
DATE
Revised 10/2017 Page 3 of 5
NAME
BUSINESS STREET ADDRESS
CITY
STATE
HOME STREET ADDRESS
CITY
STATE
BUSINESS PHONE
HOME PHONE
CELL PHONE
WEBSITE ADDRESS, IF ANY
E-MAIL ADDRESS
DRIVER’S LICENSE NUMBER
PHYSICAL DESCRIPTION
HEIGHT
WEIGHT
COLOR OF HAIR / LENGTH
EYES
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS
ARRESTING AGENCY
DATE
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS
ARRESTING AGENCY
DATE
5. ATTACH an ichat criminal background check for every peddler.
6. List the dates, times, and locations where peddling will occur.
Date
Location
Time
7. Provide the types of goods, wares, merchandise and services to be sold, offered, or for which orders will be
taken.
8. Has the applicant or parent organization ever been denied a license for peddling, had a license for peddling
suspended or revoked, or been prohibited from peddling in the Township or any other community?
If multiple Peddler’s please answer for each Peddler.
Yes No
Revised 10/2017 Page 4 of 5
9. Has the applicant, or any officer, partner, member, manager, or director of the parent organization been
convicted of a felony or any misdemeanor for a violation of federal, state or local laws, ordinances, or
regulations reflecting adversely on the applicant’s ability to conduct the business for which the license is
being sought in an honest and legal manner, including, but not limited to, burglary, theft, larceny, swindling,
fraud, unlawful business practices, any form of actual or threatened physical harm against another person, or
any type of criminal sexual conduct, and if so, a brief description of the crime or violation, including its
location and date, and an explanation of the reason therefore. Yes No
10. Attach two (2) color photographs of the applicant, one (1) being a photograph taken within sixty (60) days
prior to the date of filing of the application and the other photograph being from the applicant's driver's
license or other governmentally issued identification, with a copy of such driver's license to be attached to
the application. The photograph that is not from the applicant's driver's license shall be at least two (2) inches
by two (2) inches and shall show the head and shoulders of the applicant in a clear and distinguishing
manner. In the event that the applicant has not been issued a driver's license or it has been revoked, then the
applicant shall submit a second separate photograph with the application, such photograph being at least two
(2) inches by two (2) inches and shall show the head and shoulders of the applicant in a clear and
distinguishing manner.
11. Attach a criminal background report of the applicant's criminal history. Such reports shall be obtained by
the applicant through the Internet Criminal History Access Tool (ICHAT) for applicants residing in
Michigan and/or through another state-sponsored or authorized criminal history access source for applicants
who reside in other states or have resided in other states within five (5) years prior to the date of the
application. The applicant is responsible for all charges incurred in requesting and receiving the ICHAT
report or other criminal history report and the report must be dated within thirty (30) days of the date of the
application.
12. Attach the applicant’s and parent organization’s state of Michigan sales tax license number.
13. Attach, if under eighteen (18) years of age, the applicant must provide a copy of a valid work permit issued
by the applicant's school, school district offices or other authorized issuing agency to the applicant for
purposes of the peddling activity proposed to be undertaken in the Township.
14. Attach if the applicant will be engaging in peddling using, from, or out of a motor vehicle on the streets of
the Township, the applicant must provide information to verify that the applicant has a valid driver's license,
has not been convicted of a misdemeanor or felony moving violation within the last three (3) years, and has
not been found responsible for three (3) or more motor vehicle moving violations under the Michigan Motor
Vehicle Code or local ordinances within the last three (3) years. Any such motor vehicle shall be brought to
the Township and inspected by a designated representative of the police department and must be found to
meet any safety standards adopted by the police department and any standards adopted by the State of
Michigan, and the police department's checklist form signed by the designated police department
representative verifying such compliance shall be submitted with the application.
Revised 10/2017 Page 5 of 5
15. Attach if the applicant will be engaging in the sale of food or beverages, a health license issued by the
Oakland County Health Department. Such peddler’s equipment shall be subject to inspections by the
Oakland County Health Department at the time of application, as required by the state public health code.
16. I, the undersigned applicant, have read and understand each and every provision and requirement of
Waterford Township Code Chapter 10 Article XII regarding the regulation of charitable funds
solicitation activities in the Township and I will provide such other information that the Township requests
and deems necessary, in its reasonable discretion, to discover the truth of the matters required to be set forth
in this registration or required by Township Ordinances.
The individual signing the registration statement shall sign the statement and swear before an office
authorized to administer oaths that he/she has carefully read the registration statement and that all the
information contained therein is true and correct. Also, if a Certificate of Registration is granted, such
certificate will not be used as or represented to be an endorsement by the Township or any of its officers or
employees.
17. The Clerk’s office will add additional Peddlers to an approved application one (1) time within 30 days
of the original application date. After 30 days additional Peddlers would need to complete a new
peddler’s application along with the non-refundable fifty ($50.00) application fee.
All individuals soliciting must wear the ID badge provided by the Township.
DATE: SIGNED:
PRINT NAME:
Note: If signer is signing on behalf of a corporation, partnership or
LLC, identify the signer’s position and authority to sign in such
capacity.
Acknowledged before me on
By
Acting in County, Michigan
Notary Public
______________________________ County, Michigan
My Commission Expires:
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Peddlers Solicitors And Canvassers PDF (Charter Township of Waterford)

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Completed 17 July 2020

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