SOLICITATION REGISTRATION FORM Fee

HAINESPORT TOWNSHIP
ONE HAINESPORT CENTRE
PO BOX 477
HAINESPORT, NJ 08036
SOLICITATION REGISTRATION FORM
Fee - $50
All licenses expire December 31.
Date of Application ______________________________
Applicant’s Name ___________________________________
SS#
_______________________
Home Address ______________________________ City_________________ State _____ ZIP________
Local Address ______________________________ City_________________ State _____ ZIP________
Telephone _______________________________ DOB _________________
Age ________________
Company ID _________________________ Driver’s License # _________________________________
Have you ever been convicted of a crime:
YES _______
NO __________
If yes, please explain ____________________________________________________________________
______________________________________________________________________________________
Name of Company ____________________________________________________________________
Address ___________________________________ City_________________ State _____ ZIP________
Telephone: ___________________
Name of Supervisor ____________________________________
Nature of Activity ______________________________________________________________________
_____________________________________________________________________________________
Route you Plan to Take __________________________________________________________________
Duration of License ____________
Approximate Hours -- From _______am/pm To _______am/pm
Vehicle Type ____________________________________________________________________________
State of Registration _________________________________ Tag # _______________________________
Name of Other Individual (no more than one) __________________________________________________
Address ___________________________________ City_________________ State _______ ZIP________
(For Office Use Only)
Date Received: ______________________ Cash __________ Check # _____________
Receipt # ____________
Approved by: __________________________ Date _____________ License # ____________________
SEE REVERSE SIDE OF THIS SHEET FOR IMPORTANT INFORMATION
SOLICITATION REGISTRATION FORM
Page 2
§ 127-4. Application for license.
Every applicant for a license under this chapter shall file with the Township Clerk a sworn written
application on a form to be furnished by the Township of Hainesport which shall give or be
accompanied by the following information:
A.
Name, permanent home address, date of birth and social security number of the applicant.
B.
Local address of the applicant if different from home address.
C.
A statement of the nature of the business and a description of the merchandise or service to be
sold or of the type of solicitation to be done.
D.
If employed, the name and address of the employer, together with credentials establishing the
exact relationship.
E.
The length of time for which the license is desired.
Solicitor’s Permit
Please fill out all information on the application. Submit along with a
check in the amount of $50. made payable to Hainesport Township.
Also, please provide the following informtion along with the application
and fee.
-
Copy of driver’s license
Picture ID
Automobile Registration, Insurance
Company ID
Copy of Certificate of Authority
Health Department Certificate
Also attach a photograph taken within the last 60 days (head &
shoulders) for identification purposes.