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2. Last Name
3. First Name
4. Middle Name
6. Date of Birth
   Date of Birth
7. Place of Birth
9. Height
10. Weight
11. Hair Color
12. Eye Color
14. Social Security Number
15. Gender
16. Race
18. Drivers License Number
19. Drivers License State
21. If no state-issued ID,list other type of government issued ID
23. Local Address
25. City
26. State
27. Zip
29. Permanent Address
31. Address2
33. City
34. State
35. Zip
37. Name of Company
38. Company Phone Number
39. Taxpayer ID #
41. Company Address
43. City
44. State
45. Zip
47. Name of Manager/Supervisor
48. Manager/Supervisor Phone #
50. Type of Goods/Services being offered
52. Miscellaneous Information
54. In compliance with Article VII, Sections 8-60, 61, 62, 63 of the Carrboro Code of Ordinances, I hereby make application for a Solicitation Permit. I agree to the stipulations set forth in the above-mentioned ordinance and understand that I am subject to a criminal background check. I have listed any pertinent criminal history below.
56. List any criminal misdemeanor of felony convictions (other than traffic offenses) within the last 10 years (additional pages may be submitted if necessary):
58. Offense
59. Year/Month of Conviction
60. City and State
62. Offense
63. Year/Month of Conviction
64. City and State
66. Offense
67. Year/Month of Conviction
68. City and State
70. Offense
71. Year/Month of Conviction
72. City and State
74. Offense
75. Year/Month of Conviction
76. City and State
78. I also acknowledge and agree to the following terms:
80. -A non-refundable processing fee of $5.00 (cash or check) is due upon submission of this application.
82. -A refundable $10.00 deposit (cash only) is due upon issuance of a permit.
84. -The $10.00 deposit will be refunded to the applicant only if the permit is returned to the Carrboro Police Department no later than 5 business days after its expiration.
86. -The permit is fvalid for up to 60 days and can be renewed (up to 60 more consecutive days) for a fee of $2.00
88. -Only one renewal is allowed per application (the applicant can re-apply after the renewal has expired).
90. -The applicant must have the permit available for display while engaging in commercial solicitation within the Town of Carrboro.
92. -The permit is the property of the Town of Carrboro and must be surrendered to the Town upon revocation or expiration.
94. By typing my name I am stating that the information I have filled out is true.
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96. 1. Receive an email copy of this form.
97. Email address

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98. Submit

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