2. Solicitors are only allowed to operate between 9:00 a.m. until 7:00 p.m.
4. Applicant Information
6. First Name*
7. Last Name*
9. Phone Number*
10. Email*
12. Date of Birth*
    Date of Birth
16. Vehicle Information
18. Type of Vehicle:
19. Make:*
20. Model:*
22. Year:*
23. License Plate Number:*
24. State:*
28. Company Information
30. Company Name:*
32. Company Address:*
34. Address 2
36. City*
37. State*
38. Zip*
40. Company Telephone Number:*
41. Company Federal I.D. Number:*
43. Merchandise:*
44. Dates of Sale:*
46. Location of Solicitation*
48. Acknowledgement*

    The facts set forth above in my application for Registration Permit for Itinerant Merchant, Peddler, Solicitor are true and complete. I understand false statements shall be considered sufficient cause for denial and/or revocation. To the fullest extent permitted by laws and regulations, applicant shall identify and hold harmless the City of Eudora and its officers, employees and agents from and against all claims, suits, damages, costs, demands, losses and expenses, direct, indirect or consequential (including but not limited to fees and charges of attorneys and other professionals and court and arbitration costs) arising out of or resulting from the performance under this registration permit. The applicant is entirely and solely responsible for all acts while engaged in the operation of vending within the City of Eudora.

    1. I have read, understand, and agree to these provisions
50. Non-Endorsement*

    You should not, in any way, interpret this registration permit to mean that the City of Eudora, or any department, officer or employee thereof, endorses the applicant, the company, or the product being sold.

    1. I agree
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52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit Submit and Print

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