Permit to Solicit and Canvass Application

"*" indicates required fields

Legal Name*

First Last

Date Of Birth*

Sex*

Social Security #*

Address*

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

Home Phone

Cell Phone

Email*

Driver's License Number*

Driver's License State*

Height*

Weight*

Hair*

Eyes*

Will your vehicle be used for soliciting?*

Yes

Vehicle Registration*

Make*

Model*

Color*

Year*

Number of Children

Company Name*

Company Phone*

Supervisor's Name*

Company Address*

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?*

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

Criminal offenses

FOR EMERGENCIES 9-1-1