Peddler's License Application
Applicant Information
| First Name |
Luciano
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| Last Name |
Cervantes
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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 photograph following the guidelines: submit one color photo, submit a recent photo taken in the last six months, use a clear image of your face, do not change your photo using computer software phone apps or filters, directly face the camera without tilting your head, take off your eyeglasses for your photo, use a white or off-white background without shadows, texture, or lines. |
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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 |
House Of Light Home Solutions LLC
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| Business Address |
2910 S First St Humboldt AZ 86329
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| Business Mailing Address |
PO Box 270, Dewey AZ 86327-0270
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| Business Phone Number |
+14804637329
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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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| License Plate # |
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| State |
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Arizona Department of Revenue - Transaction Privilege Tax Number
| Please provide your Transaction Privilege Tax (TPT) Number (If none, write down service only) |
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Eligibility Form
Eligibility Form
| Choose one option: |
Arizona driver license issued after 1996 OR Arizona non-operating identification license
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| Attach a copy of said document |
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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
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