Vendor License Application

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Peddler/Vendor License

Date

Name

Name

First

First

Last

Last

Name of Business/Company

Types of goods or services vended

Address of Business/Company

Address of Business/Company

Address of Business/Company

Address of Business/Company

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Vendor Information

Home Phone

Cell Phone

Email

Address

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Date of Birth

Gender

Date Issued

Date Expired

Signature

Driver’s License Upload

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