2. Solicitors are only allowed to operate between 9:00 a.m. until 7:00 p.m.

   Licenses are valid for a period not to exceed one (1) year and shall expire on December 31 of the year in which it is issued.

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. Criminal History and Background Check*

    I certify that no person whose duties involve soliciting, canvassing, or peddling has been convicted of a crime involving more turpitude or any felony convictions, misdemeanor or ordinance violations involving force, threat of force, violence, theft, dishonesty, fraud, sexual misconduct or the violation of any laws regulating the act of soliciting or peddling within the past five (5) years in this state or any other state or subdivision thereof or of the United States. The applicant also does not have an outstanding arrest warrant in this or any other jurisdiction or is a fugitive from this or from any other jurisdiction. I, the applicant, has, subject to audit, performed the necessary background check of all such persons to ensure that theses statements are correct.

    1. I have read, understand, and agree to these provisions
52. 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 have read, understand, and agree to these provisions
54. Electronic Signature*

    I certify that I am familiar with the provisions of this chapter and will comply with all requirements set forth within; and that all of the information provided in the same application is true and correct. By checking the box below I agree and acknowledge my electronic signature is valid and binding in the same force and effect as a handwritten signature.

    1. I have read, understand, and agree to these provisions
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58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit Submit and Print

* indicates a required field