2. Office of the Township Clerk

   95 West Veterans Highway | Jackson, NJ 08527 | (732) 928-1200)

   Fax 732-928-4377

   
   

4. NOTICE OF SOLICITATION

6. ANNUAL FEE: $35.00 per Calendar year
   
   

7. DATE PAID:
   DATE PAID:
8. Image
10. Vendor Name:
12. Address
14. State
15. City
16. Zip Code
18. Phone Number
19. Email Address
21. Type of business:
23. Applicant Name (if different from Vendor Name):
25. Address
27. City
28. State
29. Zip Code

33. Applicant's place of residence (list last 5 years):

35. 1.
36. 4.
38. 2.
39. 5.
41. 3.
42. 6.
44. Has the applicant ever had an application to conduct a vending business denied or revoked? If so, please provide the details.
46. Has the applicant ever been convicted of a crime? Yes | No If Yes, please provide details
48. Please provide the following with this application:

    1. A list, on Company letterhead, of the names and addresses of the persons engaging in the canvassing, soliciting or itinerant vending.
    2. The names and addresses of the individuals or companies by which such persons are employed.
    3. A list of any motor vehicle to be used, including the make, model, color and license plate #; and all insurance information, including the name and address of the carrier, policy number, and type of coverage.
    4. A listing of the street or streets in Jackson Township in which the canvassing, itinerant vending or soliciting will take place, including the starting and ending dates, and time of day for such solicitation
    5. Proof of insurance policy (i.e. Acord form) issued by a NJ licensed company protecting the applicant and the Township from all claims or damages to property and bodily injury, including death, which may arise in connection with the applicant’s vending business activities. Said policy shall name the Township of Jackson as an additional insured and shall provide that the policy may not be terminated prior to the expiration date without at least thirty (30) days advance written notice to the Office
    6. One (1) 1-inch square photos showing the applicant’s face (must be a recent photo)
50. All itinerant vendors selling goods from a stand or vehicle must also provide:

    - Copy of valid Driver’s License
    - Copy of Business Registration Certificate
    - Copy of NJ State Tax Certificate of Authority
    
    

52. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
54. Electronic Signature
55. Date
    Date

57. This notice must be filed with the Township Clerk no less than fourteen (14)
    business days prior to the scheduled start date.
    Provide the above notice requirements have been satisfied, the Township Clerk
    shall issue a permit allowing the canvassing or soliciting to take place. This permit
    shall be valid for a period not to exceed thirty (30) days from the date of issuance.
    Once expired, the permit must be renewed following the same notice requirements.
    
    

Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit Submit and Print

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