Permit to Solicit and Canvass Application

Legal Name(Required)

First Last

Date Of Birth(Required)

Sex(Required)

Social Security #(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Email(Required)

Driver's License Number(Required)

Driver's License State(Required)

Height(Required)

Weight(Required)

Hair(Required)

Eyes(Required)

Will your vehicle be used for soliciting?(Required)

Yes

Vehicle Registration(Required)

Make(Required)

Model(Required)

Color(Required)

Year(Required)

Number of Children

Company Name(Required)

Company Phone(Required)

Supervisor's Name(Required)

Company Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How long do you wish to conduct business in the Town of Randolph?(Required)

Briefly describe the nature of the product or service you wish to solicit or canvass for. Include hours and method of operation.(Required)

Criminal offenses

FOR EMERGENCIES 9-1-1