Peddlers Permit Name * Required First Last Permanent Home Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Full Local Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone Numbers * RequiredEmail Nature of Business and Description of Merchandise to Be Sold * RequiredType of License Requested * RequiredDailyAnnualName of Employer * RequiredAddress of Employer * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Person Upon Who Legal Process and Notice May Be Served * RequiredAddress of Person Upon Who Legal Process and Notice May Be Served * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Description of Vehicle to Be Used and License Plate * RequiredLocation where merchandise is Manufactured or Produced * RequiredLocation of Merchandise at Time of Application * RequiredMethod of Delivery * RequiredHave you been convicted of any crime, misdemeanor or violation of any municipal ordinance? * RequiredYesNoPlease describe the nature of the offense, punishment and/or penalty. * RequiredIs peddling or soliciting to beconducted as a team, group or other organized party under single leadership or direction, control or sponsorship? * RequiredYesNoThe above-required personal information must be supplied for each other person involved, including the leader. * RequiredDo you represent or are you the agent for a principal? * RequiredYesNoPlease include a letter from the principal describing the nature and scope of applicant's authority, including any restrictions, limitations and conditions on the applicant and copies of each order form, contract or other form used by the applicant while peddling. * RequiredWill you be selling goods, merchandise or commodities that are required to be sold by weight, measure or count under Article 16 of the New York State Agriculture and Markets Law? * RequiredYesNoPlease include a certificate from the sealer of weights and measures certifying that weighing and measuring devices to be used by the applicant have been examined and approved. * RequiredHave you applied for a Peddler License in the Village of Greenwich previously? * RequiredYesNoPlease indicate the outcome of your application. * RequiredIs the Peddler License to be used in conjunction with a special event? * RequiredYesNoPlease indicate the name and date of the event. * RequiredIs the Peddler License for the sale of food, beverage or other consumable? * RequiredYesNoPlease attach a copy of the Washington County Department of Health Inspection Certificate. * RequiredIs the Peddler License associated with a 501(c)(3) or 501(c)(4) organization? * RequiredYesNoPlease attach a copy of all relevant documentation, including a copy of the certification letter from the Internal Revenue Service. * Required Drop files here or Is the Peddler License for a business with an agricultural exemption? * RequiredYesNoPlease attach a copy of all relevant documentation. * Required Drop files here or Is the Peddler License to be used on behalf of an established, tax-paying business located in the Village of Greenwich? * RequiredYesNoPlease indicate the business name, telephone and address * RequiredAre you an honorably discharged member of the armed forces or any other person who has obtained a license from the Washington County Clerk under Article 32 of the New York State General Business Law? * RequiredYesNoPlease attach a copy of all relevant documentation. * Required Drop files here or I acknowledge that I have read and understand the Administrative Process for violation of the conditions of my Peddler's License. * Required(Enter Initials)Applications for an annual Peddler License are subject to a $75.00 application fee. This fee will be refunded in the event that a license is not issued. If the applicant answers "Yes" to items T, U, V or W, any fee associated with the application is waived. Fees must be paid IN FULL by cash or check payable to the "Village of Greenwich" at the time the application is submitted. As determined by the Village Clerk, applications may require a photograph of the applicant taken within 60 days, or legible copy of a New York State Driver's License bearing the name and image of the applicant; and may require business references. Please allow a minimum of two weeks between the submission of this application and the date the license is required. There is no guarantee that licenses will be ready by the requested date, regardless of the date of submission. Signature * RequiredDate of Signature - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY
