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