APPLICATION
SOLICITOR/PEDDLER LICENSE
BENSALEM TOWNSHIP
Building and Planning Department
Office 215-633-3644 ▪ Fax 215-633-3753
2400 Byberry Road ▪ Bensalem, PA 19020
Permit #
Date
Tax Parcel #
To the best of his/her knowledge, the undersigned certifies that the information contained in this application is true
and correct. The information is being furnished to make application for a license to solicit and/or peddle within the
Township of Bensalem, and applicant agrees to abide by all regulations set forth in the Township Ordinance.
1. Applicant’s Full Name:
Social Security No.
Applicant’s Address
Phone No.
2. Applicant’s Age:
Hair Color:
Gender: Male
Date of Birth:
Eye Color:
Female
Race:
Driver’s License No.
State Where Issued:
OFFICE USE ONLY
APPROVED DENIED
Director of Building & Planning Date
3.
Has applicant ever been convicted or pleaded guilty to any crime?
YES NO
If Yes,
Crime Date of Conviction-Plea Location
4. Name of Employer:
Address of Employer:
Employer’s Phone No:
Employer is a :
Corporation Partnership Individual Association
5.
Name of company for whom you are soliciting?
6.
Description of item for which you will be soliciting: (Service, Article, Device, Subscription, Contract, etc.)
NOTE: Applicant is required to apply for a criminal records check through the Pennsylvania State Police.
Copy and paste the link for the website to make this application. https://epatch.state.pa.us
Employer’s Signature
Date
Applicant’s Signature
Date
A SIGNED COPY OF THIS APPLICATION IS REQUIRED PRIOR TO ISSUANCE OF LICENSE
