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CITY OF DUBLIN POLICE SERVICES COMMERCIAL PEDDLERS AND SOLICITORS PERMIT APPLICATION APPLICANT INFORMATION Name: Last First Middle Aliases Used: Permanent Home Address: City, State, Zip: Temporary/Local Address (if applicable) City, State, Zip: Home Phone: Cell Phone: Birth Date: Drivers License Number: State: Have you been convicted of any felony or misdemeanor involving injury to person(s) or property, theft, fraud or misrepresentation within the past ten years? Yes No If yes, list each conviction including date, location, charge, court and disposition of the offense: Have you failed to pay any judgment arising from or connected with the activities authorized by this permit application? Yes No Have you previously suffered revocation of a permit connected with the activities authorized by this permit application? Yes No BUSINESS INFORMATION Business Name: Address: Phone: Fax: Supervisor Name & Phone: Items or Services to be Sold: Length of time for which the right to conduct activity is desired: ---PAGE BREAK--- Revised 7/1/2024 COMMERCIAL PEDDLERS AND SOLICITORS APPLICATION CONTINUED VEHICLE INFORMATION Please provide information for any vehicles proposed to be used in conjunction with this permit. Additionally, please attach safety inspection information and proof of insurance, when applicable. Make/Model: Year: License Plate Color: Make/Model: Year: License Plate Color: Make/Model: Year: License Plate Color: APPLICANT CERTIFICATION I declare under penalty of perjury that the information contained in / or submitted with this application is true and correct. Signature Date Permit Application Checklist □ Business License issued prior to permit approval □ Two 2” x 2” Photographs □ Completion of LiveScan – Fingerprint Processing □ Health Department Permits, if applicable □ Submission of Cash Deposit or Bond, if applicable □ Submission of permit fee of $126.00 Solicitation and Sales activities are permitted between the hours of 9:00 AM and 8:00 PM. Each Peddler/Solicitor must have his/her own permit.