Peddler's License Application
Applicant Information
| First Name |
Bryan
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| Last Name |
Quick
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| Home Address (No PO Boxes) |
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| Mailing Address |
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| Phone Number |
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| Date of Birth |
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| Weight |
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| Height |
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| Sex |
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| Hair Color |
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| Eye Color |
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| Driver's License # |
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| DL State Issued |
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| DL Expiration Date |
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| Social Security # |
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| 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 |
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| Have you ever been convicted of any crime, misdemeanor or violation of any municipal ordinance other than traffic violations? |
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Employment History
| Business Name, Address, Phone Number and Length of Employment: |
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Business Name & Location
| Business/Company Name |
QUICK QUALITY GLASS LLC - DBA NOVUS GLASS OF PRESCOTT
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| Business Address |
3002 Pleasant Valley Ct, Prescott AZ 86305-4150
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| Business Mailing Address |
3002 Pleasant Valley Ct, Prescott AZ 86305-4150
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| Business Phone Number |
+14068681094
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| Please provide a brief description of the nature of the business and the goods to be sold: |
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| 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: |
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| Vehicle Information; Which car will you be driving? |
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Vehicle information
| Make |
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| Model |
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| Year |
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| Color |
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