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2. This for is an application for peddling and soliciting license.

   The fee is $25.00 per Application (Good for 30 days) and can be renewed every 30 days up to 90 days ($25.00 for each renewal).

   Permits can be picked up in the Police Department during normal business hours. (Monday through Friday from 8:00AM to 4:30PM)

   Each applicant must provide Driver’s License and Company ID at pick-up.  

   Please allow 1-3 business days for applications to be completed.

4. Applicant Name

   First, Middle, Last

6. Social Security
7. Date of Birth
9. Driver License Number
10. State
12. Street Address
14. City
15. State
16. Zip Code
18. Phone Number
19. Work Number
21. Describe Any Motor Vehicle To Be Used In The Operation Of The Solicitation
23. Vehicle Make
24. Vehicle Model
26. Vehicle Color
27. License Plate Number
29. License Plate State
30. Have you ever been charged with, indicted for, or convicted of any crime?
    -- Select One --YesNo
34. Organization or Business Information
36. Organization or Business Name
38. Address
40. City
41. State
42. Zip Code
44. Phone Number
45. Email
47. Does this busines have a License and pay Business Privilege Tax to Muhlenberg Township?*

    1. Yes
    2. No
49. Identify the relationship between the Applicant and the Organization or Business*

    1. Employee
    2. Independent Contractor
    3. Member
    4. Non-Profit

    (Please select one)

51. Type of Organization or Business*

    1. LLC
    2. Partnership
    3. Corporation
    4. Sole Proprietorship
    5. Non-Profit

    (Please select one)

53. If a Non-Profit, please describe
55. Describe the types of goods, services or product that will be offered
57. Date of Solicitation

    (License will be issued for a maximum of 30 days at a time)

59. Location of Solicitation*

    1. Door to door
    2. Public places

    (Please select one)

61. If Public Places, list location(s)

63. Note: Pursuant to the Muhlenberg Township Code, Section 100-9, all itinerant merchants, peddlers and solicitors, including non-profit corporations and agencies, shall hold harmless the Township from any liability, damage or injury which is casually related to an act of ordinary negligence on the part of such itinerant merchant, peddler or solicitor.

65. Electronic Signature Agreement

    I certify that all of the information contained in this application is true and correct.

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
67. Electronic Signature
Leave This Blank:


69. 1. Receive an email copy of this form.
70. Email address

    This field is not part of the form submission.

71. Submit

* indicates a required field