HomeMy Public PortalAbout Solicitor Permit Application and Checklist fillableAPPLICANT INFORMATION
NAME OF APPLICANT DATE OF APPLICATION
ADDRESS CITY STATE ZIP CODE
DATES FOR WHICH PERMIT IS DESIRED: THROUGH
(60 Days Maximum)
BUSINESS INFORMATION
BUSINESS NAME TELEPHONE #NAME OF IMMEDIATE SUPERVISOR OR BUSINESS MANAGER
ADDRESS CITY STATE ZIP CODE
TELEPHONE #DRIVER’S LICENSE NUMBER DRIVER’S LICENSE STATE
DATE OF BIRTH SEX
M F X RACE HEIGHT WEIGHT HAIR COLOR
LIST ALL PRODUCTS YOU WILL BE SELLING
LIST ANY COMMUNITIES WHERE YOU HAVE SOLICITED IN THE LAST SIX MONTHS
CITY OR COUNTY AND STATE START DATE END DATE
CITY OR COUNTY AND STATE START DATE END DATE
CITY OR COUNTY AND STATE START DATE END DATE
BUSINESS DOING BUSINESS AS (DBA)
ILLINOIS DEPT. PROFESSIONAL REGULATION LICENSE NUMBER: Expires:
* If yes, we require you to provide your customer with an information packet regarding the Plainfield alarm ordinance and their responsibilities if
they choose to have an alarm installed in their residence or business.
I hereby certify that the foregoing information is true and correct to the best of my knowledge, and as an applicant, consent to
independent verification of the information provided and agree to abide by the terms and regulations prescribed in the Village of Plainfield
Solicitors Ordinance and by the terms of any license issued there under.
SIGNATURE OF APPLICANT DATE OF APPLICATION
PLAINFIELD POLICE DEPARTMENT
14300 S. COIL PLUS DR.
PLAINFIELD, IL 60544
(815) 436-6544 – Fax: (815) 436-1486
SOLICITOR APPLICATION
DEPARTMENT STAMP
RECEIVED BY: _
CITY OR COUNTY AND STATE START DATE END DATE
ALARM COMPANIES ARE REQUIRED TO BE LICENSED BY THE STATE OF ILLINOIS. PLEASE PROVIDE THE FOLLOWING
INFORMATION:
SECURITY ALARM SALES: Specify if door-to-door solicitation includes a point-of-sale application process. YES NO
STATE:
STATE:
STATE:
STATE:
STATE:
STATE:
STATE:
STATE:
STATE:
PROVIDE THE FOLLOWING INFORMATION FOR EACH PERSON SOLICITING
DATE OF BIRTH:
ZIP:STATE:ADDRESS:
PHONE NUMBER:NAME: (LAST – FIRST – MIDDLE)
IF MINOR, PROVIDE EMPLOYMENT CERTIFICATE # OR DEPT OF LABOR PERMIT #:EXPIRES:DRIVERS LICENSE #:
DATE OF BIRTH:
ZIP:STATE:ADDRESS:
IF MINOR, PROVIDE EMPLOYMENT CERTIFICATE # OR DEPT OF LABOR PERMIT #:EXPIRES:DRIVERS LICENSE #:
DATE OF BIRTH:
ZIP:STATE:ADDRESS:
IF MINOR, PROVIDE EMPLOYMENT CERTIFICATE # OR DEPT OF LABOR PERMIT #:EXPIRES:DRIVERS LICENSE #:
DATE OF BIRTH:
PHONE NUMBER:NAME: (LAST – FIRST – MIDDLE)
PHONE NUMBER:NAME: (LAST – FIRST – MIDDLE)
ZIP:
IF MINOR, PROVIDE EMPLOYMENT CERTIFICATE # OR DEPT OF LABOR PERMIT #:EXPIRES:DRIVERS LICENSE #:
DATE OF BIRTH:
ZIP:STATE:ADDRESS:
PHONE NUMBER:NAME: (LAST – FIRST – MIDDLE)
USE ADDITIONAL SHEETS IF NEEDED.
DATE OF BIRTH:
ZIP:STATE:ADDRESS:
IF MINOR, PROVIDE EMPLOYMENT CERTIFICATE # OR DEPT OF LABOR PERMIT #:EXPIRES:DRIVERS LICENSE #:
DATE OF BIRTH:
ZIP:STATE:ADDRESS:
IF MINOR, PROVIDE EMPLOYMENT CERTIFICATE # OR DEPT OF LABOR PERMIT #:EXPIRES:DRIVERS LICENSE #:
STATE:ADDRESS:
ZIP:STATE:
IF MINOR, PROVIDE EMPLOYMENT CERTIFICATE # OR DEPT OF LABOR PERMIT #:EXPIRES:DRIVERS LICENSE #:
DATE OF BIRTH:
IF MINOR, PROVIDE EMPLOYMENT CERTIFICATE # OR DEPT OF LABOR PERMIT #:EXPIRES:DRIVERS LICENSE #:
DATE OF BIRTH:
ZIP:STATE:ADDRESS:
IF MINOR, PROVIDE EMPLOYMENT CERTIFICATE # OR DEPT OF LABOR PERMIT #:EXPIRES:DRIVERS LICENSE #:
PHONE NUMBER:NAME: (LAST – FIRST – MIDDLE)
PHONE NUMBER:NAME: (LAST – FIRST – MIDDLE)
PHONE NUMBER:NAME: (LAST – FIRST – MIDDLE)
PHONE NUMBER:NAME: (LAST – FIRST – MIDDLE)
PHONE NUMBER:NAME: (LAST – FIRST – MIDDLE)
ADDRESS:
CITY:
CITY:
CITY:
CITY:
CITY:
CITY:
CITY:
CITY:
CITY:
NEW SOLICITOR PERMIT APPLICATION CHECKLIST
THE FOLLOWING ITEMS MUST BE SUBMITTED WITH THIS APPLICATION:
Completed Solicitor Permit Application
Solicitor Permit Fee ($50 for primary applicant and $35/each for any additional applicant;
Maximum of 14 solicitors)
A 2x2 photo for each person soliciting, i.e. passport photo. Do not staple or bend the photo. The
image may be personally taken and printed on any photo or standard paper so long as the image is
clear, and the solicitor is facing the camera with no sunglasses, hats or scarves unless worn for
religion. We reserve the right to reject an unsuitable photograph.
Attach a copy of a Government ID issued for each solicitor
If you are handing out literature, please attach a copy. If there is no literature, please attach your
business card to this application form.
Certificate of Good Standing. If the business operates as a Corporation or a Limited Liability
Company (LLC) please attach a copy of the certificate.
Certificate of Ownership of Business. If the business operates as a sole proprietorship or general
partnership, please attach a copy of the Certificate of Ownership of Business. In the event the
solicitors are doing business as (DBA), please provide proper business filings.
Illinois Department of Financial & Professional Regulation License. If the business requires a
license from the IDFPR, please attach a copy of the license.