Pho
n
CI
T
CIT
Y
104
Edg
e
citycle
r
n
e: (386) 424-
2
Each pe
r
an appli
c
person f
accomp
a
valid for
The Cit
y
work ca
n
receipt
o
complet
e
Applicat
i
no fewe
r
commen
c
An inco
m
1)
D
2)
C
3) S
4)
T
f
i
h
5) F
T
Y OF ED
G
Y
CLERK’
S
North Rive
e
water, Fl
o
r
k@cityofe
d
2
400 X 1102
r
son wishin
g
c
ation to th
e
o
r the back
g
a
ny the com
p
a period no
t
y
requires a
n
be initiate
o
f the back
g
e
, the City C
i
ons for pe
d
r
than five
w
c
e solicitati
o
m
plete appli
c
T
D
rivers Licen
s
C
ity or Count
y
tate Licens
e
T
wo photogr
i
ling of the
ead and sho
u
ingerprints
(
EWATER
S
OFFICE
rside Drive
rida 32132
d
gewater.
o
FAX: (3
g
to Peddle,
e
City Cler
k
g
round che
c
p
leted appli
c
t
to exceed t
h
criminal b
a
d within th
e
g
round chec
k
lerk’s Depa
r
d
dlers, solici
t
w
orking da
y
o
ns.
c
ation will
d
T
he followi
n
s
e or State Is
s
y
Business T
a
e
(If Applica
b
aphs of the
application,
u
lder of the
(
may be obt
a
o
rg
86) 424-2410
Solicit, or
C
k
. An appli
c
c
k (if not c
o
c
ation. A P
e
h
ree month
s
a
ckground c
h
e
City of E
d
k
and revie
w
r
tment will
n
t
ors and ca
n
y
s in advan
d
elay the per
n
g items mus
t
s
ued Identific
a
a
x Receipt
b
le)
applicant ta
k
which shal
l
applicant in
a
ined at the
E
SO
L
C
anvass wit
h
c
ation fee o
f
o
mpleted an
e
ddler, Soli
c
s
.
h
eck for ea
c
d
gewater w
h
w
by the P
n
otify you o
f
n
vassers sha
l
c
e of the d
a
m
itting pro
c
t
be submitt
e
a
tion Card
k
en within
6
l
be at least
a clear and
E
dgewater
P
L
ICITOR
S
h
in in the Ci
t
f
$30.00 pe
r
d on file f
o
c
itor and C
a
c
h person li
h
ile the pro
c
olice Depa
r
f
the status
o
l
l be submit
t
a
te upon w
h
c
ess.
e
d with the
a
6
0 days im
m
two inches
distinguish
a
P
olice Depa
r
S
PERMI
T
t
y of Edge
w
r
business
a
o
r previous
a
nvasser Re
g
i
sted on the
cess is ong
o
r
tment. On
c
o
f your per
m
t
ed to the C
h
ich the ap
p
a
pplication:
m
ediately p
r
by two inc
a
ble manner.
r
tment for
a
T
APPLI
C
w
ater must s
u
a
nd a $15 f
e
12 months)
g
istration sh
a
application
.
o
ing and pr
i
c
e this revi
e
m
it.
ity Clerk’s
o
p
licant wis
h
r
ior to the d
a
hes, showi
n
.
a
fee of $10)
C
ATION
u
bmit
e
e per
must
a
ll be
. No
i
or to
e
w is
o
ffice
h
es to
a
te of
n
g the
Pho
n
1
All state
m
Please pr
i
BUSIN
E
Name
Address
Phone
Name an
d
represent
APPLI
C
Name
Date of B
Drivers L
Permane
n
Telephon
e
Tempora
r
LIST A
L
Make/Co
l
Tag Num
b
Make/Co
l
Tag Num
b
The date(
CI
T
CI
T
104
Ed
g
ne: (386) 424-
2
m
ents made b
y
i
nt.
E
SS INFO
R
d
Title of a
n
the organiza
t
C
ANT INF
O
irth
icense Num
b
n
t Address (I
n
e
Number
r
y Address (I
n
L
L VEHIC
L
l
or
b
er
l
or
b
er
s
) of solicitat
T
Y OF ED
G
T
Y CLERK
North Riv
e
g
ewater, Fl
o
2
400 X 1102
y
the applica
n
R
MATION
n
officer of
t
ion
O
RMATIO
N
b
er
n
clude City
&
n
clude City
&
L
ES TO B
E
i
on/business
G
EWATER
S OFFICE
e
rside Driv
e
o
rida 3213
2
FAX: (
3
n
t upon this a
p
such organi
z
N
&
State)
&
State)
E
USED
s
ales is to be
e
2
3
86) 424-2410
p
plication or
z
ation who c
Model
Drivers Na
m
Model
Drivers Na
m
conducted i
n
SO
L
in connectio
n
an verify th
e
State of I
Y
m
e
(
A
Y
m
e
(
A
n
the City of
E
L
ICITOR
S
Offi
c
Ap
p
Bac
k
Tot
a
n
therewith,
s
e
authority
o
I
ssuance
Y
ear
A
ttach copy o
f
Y
ear
A
ttach copy o
f
E
dgewate
r
:
S
PERMI
T
ceUseOnly
p
licationFee$
3
k
groundChec
k
a
lAmountDu
e
s
hall be unde
r
o
f the applic
a
f
DL)
f
DL)
T
APPLI
C
3
0
k
($15/person
)
e
$
r
oath.
a
nt
t
o
C
ATION
)
$
2
The nature of solicitation to be conducted and a brief description of any goods or services offered:
The proposed method of delivery of goods or services:
Place where applicant can be contacted for at least seven days after leaving the City:
Name of three previous cities where applicant (or organization representative) conducted similar
solicitations:
1) 2) 3)
Have you had any convictions, nolo-contendere pleas or forfeitures for violating any local, state or federal
law, excluding traffic fines of $50 or less Yes No If yes, describe the nature, location and penalty
imposed:
Have you and/or represented organization:
1) Engaged in solicitation of a similar nature in the City before? Yes No
2) If so, has any license, permit or registration issued by the City ever been revoked? Yes No
I have read and agree to all of the above conditions and agree that the application is complete and correct.
Applicant Signature
STATE OF FLORIDA
COUNTY OF VOLUSIA
Before me this day personally appeared who, being duly sworn, deposes
and says the application is true and correct. Sworn to (or affirmed) and subscribed before me this day of
, 20 Personally known or produced identification type of identification
Notary Signature
Commission Expiration
Do not Write Below This Line – Office Use Only
Police Department
We have reviewed and approve not approve the registration of this applicant.
Review completed by Date
Signature
City Clerk’s Office
Registration has been approved denied
Date Signature
3
ADDITIONAL APPLICANTS INFORMATION
Date
Name
Last First Middle
Alias
Race Sex Date of Birth
Current Address
Street City State Zip Code
Drivers License Number
(attach copy of Drivers License)
VEHICLE USED BY APPLICANT
MAKE/COLOR MODEL YEAR
TAG NUMBER
Name of three previous cities where applicant (or organization representative) conducted similar solicitations:
1) 2) 3)
Have you had any convictions, nolo-contendere pleas or forfeitures for violating any local, state or federal law,
excluding traffic fines of $50 or less Yes NoIf yes, describe the nature, location and penalty imposed:
Have you and/or represented organization:
1) Engaged in solicitation of a similar nature in the City before? Yes No
2) If so, has any license, permit or registration issued by the City ever been revoked? Yes No
I have read and agree to all of the above conditions and agree that the application is complete and correct.
Applicant Signature
STATE OF FLORIDA
COUNTY OF VOLUSIA
Before me this day personally appeared who, being duly sworn, deposes
and says the application is true and correct. Sworn to (or affirmed) and subscribed before me this day of
, 20 Personally known or produced identification type of identification
Commission Expiration
Notary Signature
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome