Peddler's License Application
Applicant Information
| First Name |
Marc
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| Last Name |
Kroll
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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 |
Southwest Auto and RV LLC dba Southwest Truck & RV
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| Business Address |
8626 E Long Mesa Dr, Prescott Valley AZ 86314-9349
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| Business Mailing Address |
8626 E Long Mesa Dr, Prescott Valley AZ 86314-9349
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| Business Phone Number |
+19287723424
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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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Vehicle information
