Town of Manchester

TOWN OF MANCHESTER APPLICATION FOR VENDOR – SOLICITOR – PEDDLER LICENSE

DATE: ______FEE: Resident $50.00 FEE: Non-Resident $100.00 Military Veteran Y or N

GENERAL INFORMATION

Applicant Name (print) ______Home Address ______City______State ______Zip______Telephone (H) ______(W) ______(C) ______Date of Birth Social Security Number Driver’s License # State/Expiration Date Name of Employer or Business Name ______Business Address ______Describe the nature of the business or the goods to be sold: ______

______Please provide the following for all vehicles to be used:

1. Make ______Model ______Year ______Color ______Reg. # ______2. Make ______Model ______Year ______Color ______Reg. # ______Please review the attached “Rules and Regulations” for vending before proceeding.

Item #1: Are you selling door to door?

Yes Proceed to Item #4.

No Proceed to Item #2.

Item #2: Are you selling from private property? Location address: Yes Contact the Zoning Officer located ______at the Building Dept., 494 Main Street, Zoning Official Signature 2nd Floor, for location approval. Upon completion, proceed to Item #4. ______Printed Name of Official Date No Proceed to Item #3.

Item #3: Are you selling from public property at a specific location? R 6-11-2013 1 MPD 147 Requested location address:

Yes Obtain a plot plan identifying your ______vending location from the Town Manchester Police Signature Engineering Department, Maps and Records, 494 Main Street, 2nd Floor. ______Submit the plot plan to the Manchester Printed Name of Official Date Police Department, Records Division, 239 East Middle Turnpike for traffic ______proceed to Item #4. Approved Location

No Proceed to Item #4.

Item #4: Are you selling food?

Yes Contact the Town Health Department ______located at 479 Main Street, 2nd Floor, Health Department Official Signature telephone (860) 647-3173, for application or download application at www.manchesterct.org. Upon completion, proceed to “Acknowledgements”. ______Printed Name of Official Date

No Proceed to “Acknowledgements”.

Acknowledgements I hereby acknowledge that I have received a copy of the Rules and Regulations for Peddling and Soliciting.

I hereby authorize and acknowledge that a criminal records check may be conducted by the Manchester Chief of Police or his designee.

Signature of applicant: ______Date: ______

To obtain Vendors License submit this completed application to: Manchester Police Records Division located at 239 Middle Turnpike East Office use only Copy of Driver’s License Copy of Veteran Form DD 214 Criminal Record Check

Fee Paid $ on .

Approved ____ Denied ____ Signature ______Date______

Notification sent to: Board of Health Manchester Fire Department. 8th District Fire Department

R 6-11-2013 2 MPD 147