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CITY OF LONE TREE SOLICITATION REGISTRATION 9220 Kimmer Drive, Suite 100 Lone Tree, CO 80124 SOLICITOR INFORMATION Solicitor’s Name: Date: Solicitor’s Address: ID #(Attach copy); City: State: ZIP Code: Phone: Date of birth: Age: Sex: Height: Weight: Eyes: Hair: Vehicle Make: Model: Year: License Plate State: Have you ever been convicted in any state of a felony, misdemeanor or ordinance violation other than traffic offenses? YES If yes, give full details including date, location of conviction, penalty imposed, and nature of charge: State purpose of Registration (solicitation, hawking, peddling, canvassing) and describe intended activity, or attach copy of literature to be distributed: ORGANIZATION OR BUSINESS INFORMATION Organization or Business Represented by Applicant: DBA Name (if applicable): Organization or Business Address: City: State: Zip Code: COLT Business License Colorado State Sales Tax Phone: Fax: Website: E-mail: Years with Organization: COST AND DURATION OF LICENSES Description Period Fee Solicitor (persons requesting a donation or distributing a commercial flyer for Non-Profit/Political Organizations) 1 Year No Fee Canvasser (persons enlisting support or distributing a non-commercial flyer for religious, philosophical, ideological, or political party issue or candidate; donations can be accepted but not requested) 1 Year No Fee Peddler/Hawker (persons who are selling goods or services) 1 Day/Month/Year $2.00/$12.50/$35.00 Peddler/Hawker (persons who are selling goods or services and are a current COLT Business License Holder) 1 Year No Fee CITY OF LONE TREE USE ONLY Per Lone Tree Municipal Code §6-2-20 Each Person operating under a solicitation permit shall carry the permit on his or her person at all times while engaged as a hawker, peddler or solicitor and shall produce such permit upon request of an officer, agent or resident of the City. Registration Number: Registration Date: Description of Registration: New: Renewal: Registration Good From: Expiration Date: SIGNATURE BY SIGNING BELOW, I AGREE TO ABIDE BY THE TERMS, CONDITIONS AND REQUIREMENTS OF CHAPTER 6 OF THE LONE TREE MUNICIPAL CODE (THE “CODE”) AND I UNDERSTAND THAT IN ADDITION TO ANY CIVIL OR CRIMINAL PENALTIES AUTHORIZED BY THE CODE, THE CITY OF LONE TREE MAY REVOKE MY REGISTRATION TO SOLICIT, HAWK, PEDDLE OR CANVASS WITHIN THE CITY LIMITS SHOULD I FAIL TO ABIDE BY SAID CODE. Signature: Date: