2. LICENSE APPLICATION FOR PEDDLERS, CANVASSERS, & TRANSIENT MERCHANTS
4. Non-Refundable License Fee: $125 includes background check. In accordance with Municipal Code Chapter 12, Section 12.05 THE FOLLOWING QUESTIONS MUST BE ANSWERED COMPLETELY.
6. Applicant Information
8. Name*
   First/M.I./Last
10. Address*
    Street/City/State/Zip
12. Phone Number*
13. Driver's License Number*
14. State Issued*
16. Height*
17. Weight
18. Hair Color*
19. Eye Color*
21. Date of Birth*
22. Email Address*
23. Copy of Driver's License*
25. Vehicle Make*
26. Model*
27. License Plate #*
29. Have you ever been TICKETED, ARRESTED, CONVICTED or FINED for ANY VIOLATION of FEDERAL, STATE or CITY LAWS RELATED TO THE APPLICANT’S TRANSIENT MERCHANT BUSINESS OR SOLICITING WITHIN THE LAST FIVE (5) YEARS – including felony, misdemeanor, civil offenses and/or traffic offenses?*

    1. Yes
    2. No
31. If yes, give date, municipality and violation
33. If yes, give date, municipality and violation
35. If yes, give date, municipality and violation
37. Information Regarding the Business or Organization Requesting License
39. Name of Organization*
41. Permanent Address*
43. City*
44. State*
45. Zip*
46. Phone Number*
48. Temporary Address If Applicable
50. City
51. State
52. Zip
53. Phone Number
55. Nature of Business*
57. Describe Activity to be Licensed*
59. List Recent Cities, Villages, Towns where applicant conducted similar business or solicitations:
    Date/Municipality
61. Date/ Municipality
63. Date/Municipality
65. List Desired Dates for License: (from)___/____/____ (to) ____ /____/____ *
66. Total Days*
68. Is food license required:*

    1. Yes
    2. No
69. $500 Surety Bond Required?

    1. Yes
    2. No

    (Check yes if applicant is not a Waukesha County resident or represents a firm whose principal place of business is located outside of the State).
71. The undersigned hereby applies for a Peddler’s License under the provisions of the City of Delafield Municipal Code Chapter 12.05. I certify that I am familiar with the laws, ordinances and regulations pertaining to this license, and I hereby agree if granted said license, to obey all provisions of said laws, including the time limitation. No person shall conduct any of the activities enumerated in Sub. (1) of City of Delafield Municipal Code Section 12.05 except between the hours of 8:00 AM and 7:00 PM or dusk, whichever occurs earlier.
73. I understand incomplete and incorrect information may lead to the denial of this license.
75. By Submitting this form, you have read and understand the information in this application and will adhere to all rules and regulations set forth by the City of Delafield.
Leave This Blank:


77. 1. Receive an email copy of this form.
78. Email address

    This field is not part of the form submission.

79. Submit

* indicates a required field