Peddler's License Application
Applicant Information
| First Name |
Lisa
|
| Last Name |
Burleson
|
| Home Address (No PO Boxes) |
---
|
| Mailing Address |
---
|
| Phone Number |
---
|
| Date of Birth |
---
|
| Weight |
---
|
| Height |
---
|
| Sex |
---
|
| Hair Color |
---
|
| Eye Color |
---
|
| Driver's License # |
---
|
| DL State Issued |
---
|
| DL Expiration Date |
---
|
| Social Security # |
---
|
| Please include a recent photograph approximately two inches by two inches (2"x2") showing the head and shoulders of the applicant in a clear and distinguishing manner |
---
|
| Have you ever been convicted of any crime, misdemeanor or violation of any municipal ordinance other than traffic violations? |
---
|
Criminal History
| If Yes, please explain the nature of your conviction: |
---
|
| If Yes, explain: |
---
|
Employment History
| Business Name, Address, Phone Number and Length of Employment: |
---
|
Business Name & Location
| Business/Company Name |
Sun Run
|
| Business Address |
2848 W Sweetwater Ave, Phoenix AZ 85029-1430
|
| Business Mailing Address |
2848 W Sweetwater Ave, Phoenix AZ 85029-1430
|
| Business Phone Number |
+19288992093
|
| Please provide a brief description of the nature of the business and the goods to be sold: |
---
|
| Please provide the source of supply of the goods or property proposed to be sold, or orders taken for the sale thereof; the location of the goods or products at the time this application is filed; and the proposed method of delivery: |
---
|
| Vehicle Information; Which car will you be driving? |
---
|
Vehicle information
| Make |
---
|
| Model |
---
|
| Year |
---
|
| Color |
---
|
| License Plate # |
---
|
| State |
---
|
Arizona Department of Revenue - Transaction Privilege Tax Number
| Please provide your Transaction Privilege Tax (TPT) Number (If none, write down service only) |
---
|
Eligibility Form
Eligibility Form
| Choose one option: |
Arizona driver license issued after 1996 OR Arizona non-operating identification license
|
| Attach a copy of said document |
SKMBT_C454e22071511580.pdf
|
Applicant Affidavit
| By submitting this application, I hereby certify that the statements made herein have been examined by me and are truthful to the best of my knowledge and understanding. |
Agree
|
