CITY OF STAFFORD
REGISTRATION STATEMENT
For any Peddler, Solicitor, Canvasser, or Itinerant Vendor.
1
Business Information
Name of Firm: ______________________________________________________________________________
Permanent Address (Street): __________________________________________________________________
City, State & Zip: ____________________________________________________________________________
Local Address (Street): _______________________________________________________________________
City, State & Zip: ____________________________________________________________________________
List the last (4) communities in which business was conducted by the Firm, with the period (start and ending
month / year):
_________________________________________________________________________________________
From Month / Year To Month / Year Name of Community
__________________________________________________________________________________________
From Month / Year To Month / Year Name of Community
_________________________________________________________________________________________
From Month / Year To Month / Year Name of Community
__________________________________________________________________________________________
From Month / Year To Month / Year Name of Community
Describe the business and related activities to be conducted: ________________________________________
__________________________________________________________________________________________
Provide the character and description of commodities, goods, merchandise, or services to be offered:
__________________________________________________________________________________________
List the location or location from which business or other activities will be conducted: ____________________
__________________________________________________________________________________________
List the term or period during which the business and activities will be conducted, not to exceed 180 days.
From: ____________________ To: ____________________
Vehicles
Describe all vehicles to be operated under the registration certificate being applied for:
Year
Make
Model
Color
State / License Plate #
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: _________________
click to sign
signature
click to edit
click to sign
signature
click to edit
CITY OF STAFFORD
REGISTRATION STATEMENT
For any Peddler, Solicitor, Canvasser, or Itinerant Vendor.
3
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: _________________
Check List
(To be attached to application form)
________ Certified copy of Charter or Articles of Corporation or; (if not incorporated under the laws of
this State)
________ Certified copy of authority to do business in this State
________ Description of each individual who will be involved in business under the registration certificate
(individuals must present a current driver’s license)
________ Description of each vehicle that will be operated under the registration certificate
________ $25.00 Registration Fee
________ Photograph Must be a recent color or black and white photo, no larger than 2”x2”
FOR OFFICE USE ONLY:
Date Received: ____________ Application complete: Y N Processed by: _____________________
click to sign
signature
click to edit