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APPLICATION FOR SOLICITOR/PEDDLER/CANVASSER LICENSE PAGE 1 OF 2 CITY OF MOSCOW SOLICITOR / PEDDLER / CANVASSER LICENSE – NEW APPLICATION PROOF OF REGISTRATION FORM THE CITY OF MOSCOW REQUIRES: 1. A processing fee of $62 with this Application which includes the background check and fingerprinting charges. Fee is nonrefundable. 2. A valid Driver’s License or other DMV approved identification to be shown and copied. 3. Photograph taken within the last sixty days of the date of this application (approximately two inches by two inches that shows the head and shoulders in a clear and distinguishing manner). Fingerprints must be completed at the Moscow Police Department (155 Southview Ave.). Call 883-7054 for hours of fingerprinting. Name LAST FIRST MIDDLE (MAIDEN) Permanent Address STREET CITY STATE ZIP Local Address: STREET CITY STATE ZIP Driver’s License: Social Security NUMBER STATE ISSUED Date of Birth: Place of Birth (City & State): Cell or Local Phone Email: Business Name or Employer Name: Business Address STREET CITY STATE ZIP Business Phone Fax Number: Tax ID#: Briefly describe the nature of your business and goods to be sold or services to be performed: State the place of manufacture or production of the goods to be offered for sale: Present location of such goods: Proposed method of delivery: Have you been issued a peddler’s or solicitor’s license by any city in Idaho in the last five years? [ ] YES [ ] NO If “YES” above, what city: (Continue to second page on the back of this sheet) ---PAGE BREAK--- APPLICATION FOR SOLICITOR/PEDDLER/CANVASSER LICENSE PAGE 2 OF 2 Have you ever, anywhere or at any time, been found guilty of, plead guilty to, received a withheld judgement, or admitted to the elements of any crime listed in Moscow City Code Section 9-3-8 or acknowledged there is sufficient evidence where a judge or jury could find you committed any of the offenses listed in MCC 9-11-9 beyond a reasonable doubt? [ ] YES [ ] NO If you answered “YES” above, please state the following for each offense: DATE OF OFFENSE NATURE OF OFFENSE PENALTY ASSESSED I, the undersigned applicant, swear that if a vendor licesne is granted to me, it will not be used or represented as an endorsement by the City of Moscow for soliciting/peddling/canvassing operations thereunder. I also acknowledge, certify and declare that I have read all of the above, and declare under penalty of perjury pursuant to the law of the State of Idaho that each and every statement made is true, correct and complete. REQUIREMENT: SIGN IN FRONT OF A MOSCOW POLICE DEPARTMENT DEPUTY CLERK Applicant’s Signature Date ATTEST: Clerk/Deputy Signature Date Updated 01/2025