Application for Solicitor Permit - COMPANY

INFORMATION ON THIS APPLICATION IS PUBLIC RECORD

ATTENTION: Before completing this application, you will need the document listed below saved to your computer and available to upload with this application.

Company is responsible for updating all changes in Company's Solicitors List as needed.

TOTAL FEES DUE WITH THIS APPLICATION = $125.00
> Application fee = $50.00
> Supervisor background check fee = $75.00

Any information you enter on this application will not be saved if you begin and return later.

* indicates required field
Proof of Registration or Certificate of Good Standing from the CO Secretary of State*
IF APPLICANT IS A FOREIGN CORPORATION OR AN EMPLOYEE OF SUCH CORPORATION, STATE IN WRITING THE NAME, ADDRESS AND TELEPHONE NUMBER OF AN AGENT FOR PROCESS RESIDING IN THE STATE OF COLORADO:
Colorado State Sales Tax Number:*
Town of Timnath Sales Tax Number:*
Type of Company*
- Individual
- Partnership
- Corporation
- LLC
Company*
Corporate Name*
Business Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address (if different from above)
Street Address Address Line 2 City State ZIP Code
Business Phone*
Corporate Phone
Business Fax
Corporate Fax
Email Address*
Website
Description of the nature, character, and the type of goods or merchandise to be sold*
SUPERVISOR/MANAGER
Name*
First Last
Title*
SUPERVISOR/MANAGER Address*
Street Address Address Line 2 City State ZIP Code
SUPERVISOR/MANAGER Email*
SUPERVISOR/MANAGER Phone*
I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. I FURTHER UNDERSTAND THAT ANY FALSE STATEMENT OR OMISSION OF INFORMATION WILL BE CAUSE FOR LICENSE SUSPENSION, REVOCATION, OR GROUNDS FOR THE TOWN TO REFUSE TO ISSUE THE LICENSE.
Signed*
First Last
Title*
Email*
Date*
Date Format: MM slash DD slash YYYY
CAPTCHA
Date Issued:______________________________________
Expiration Date:______________________________________

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