CITY OF STAFFORD
REGISTRATION STATEMENT
For any Peddler, Solicitor, Canvasser, or Itinerant Vendor.
2
Name of Applicant: __________________________________________________________________________
Last First Middle
Height: __________ Weight: __________ Sex: __________ Hair Color: __________
Social Security #: _________ - ________ - ___________ Drivers License #: _______________ State: _______
Permanent Home Address (Street): _____________________________________________________________
City, State & Zip: ____________________________________________________________________________
Local Address (Street): _______________________________________________________________________
City, State & Zip: ____________________________________________________________________________
Home Phone: ___________________ Cell Phone: ___________________ Work Phone: ___________________
Have you ever been convicted of a felony or misdemeanor involving moral turpitude? Yes No
If yes, separately list and explain the nature of each and every conviction, give the State where the conviction
occurred and the year of conviction.
Applicant’s Signature: ________________________________________________ Date: _________________
Individuals
(Please list any other individuals that will be working under this application)
Name: ____________________________________________________________________________________
Last First Middle
Height: __________ Weight: __________ Sex: __________ Hair Color: __________
Social Security #: _________ - ________ - ___________ Drivers License #: _______________ State: _______
Permanent Home Address (Street): _____________________________________________________________
City, State & Zip: ____________________________________________________________________________
Local Address (Street): _______________________________________________________________________
City, State & Zip: ____________________________________________________________________________
Home Phone: ___________________ Cell Phone: ___________________ Work Phone: ___________________
Have you ever been convicted of a felony or misdemeanor involving moral turpitude? Yes No
If yes, separately list and explain the nature of each and every conviction, give the State where the conviction
occurred and the year of conviction.
Applicant’s Signature: ________________________________________________ Date: _________________
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