Solicitors/peddlers must register and receive approval from the City of Avon Lake Safety Director to canvas.

* - required

Applicant's Name * 

Social Security Number * 

Home Address * 

City, State, Zip * 

State AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY

County * 

Telephone * 

Date of Birth * 

Place of Birth * 

Driver's License/State ID No. * 

Issuing State * 

State AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY

Sex * 

Marital Status * 

Height * 

1' 2' 3' 4' 5' 6' 7' 8'

0" 1" 2" 3" 4" 5" 6" 7" 8" 9" 10" 11"

Weight * 

Hair & Eye Color * 

In Case of Emergency, Notify

Name * 

Address * 

City, State, Zip * 

State AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY

County * 

Telephone * 

Relationship * 

Present Employer

Employer Name * 

Employer Address * 

City, State, Zip * 

State AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY

County * 

Telephone * 

Employed Since * 

Immediate Supervisor * 

Supervisor Telephone * 

Name of Firm, Corporation, or Association for Whom Canvassing is being Done * 

 

Address * 

City, State, Zip * 

State AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY

County * 

Telephone * 

Tax ID Number * 

Brief Description of Goods Sold, Service to be Rendered, or Funds Solicited * 

 

Contact will be Made by * 

Phone

In Person

Vehicle Used * 

License Plate * 

State AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY

List of All Municipalities in Which Applicant has Canvassed or Solicited During the Past Twelve Months * 

 

List All Firms, Corporations, or Associations Whom Applicant has Worked for in the Past Three Years * 

 

If applicable, has applicant complied with the requirements of Ohio R. C. Chapter 1716 pertaining to charitable solications? * 

 

Yes

No

N/A

Has applicant ever been convicted of a felony violation, or misdemeanor? * 

 

Yes

No

If Answering YES, Applicant Must Give the Date and Charge * 

 

Has applicant ever had a permit revoked for Canvassing, Peddling, or Solicitation in the City of Avon Lake or any other Municipality? * 

 

Yes

No

If Answering YES, Applicant Must Give the Date and Municipality * 

 

Applicant Photo

Upload Applicant Photo

 

I acknowledge that I will not approach homes on the Do Not Knock list.

 

I acknowledge the hours permitted are 9 am to 30 minutes following sunset from October 1 through March 31, or 9 am to 9 pm from April 1 through September 30.

Solicitation Fee * 

One Month - $15.00

One Year - $60.00

Signature of Applicant * 

Date Signed *