Additional Associate

Individual applicant information for additional associate solicitor working for a Door-to-Door Solicitor Organization

Application Date*
MM slash DD slash YYYY
Associate Agent for Individual/Organization Name*
Full Name*
First Last
Salisbury Municipal Code Requirements for Door-to-Door Solicitors*
- I have reviewed Salisbury Municipal Code Chapter 5.34 pertaining to Door-to-Door Solicitors
Permanent Address*
Street Address City State ZIP Code
Local Address if Different than Permanent Address*
Street Address City State ZIP Code

if None, put N/A in all address fields
Phone*
Email*
Enter Email Confirm Email
Date of Birth*
Month
Day
Year
Height*

ex. 5 ft. 5 in.
Weight*

ex. 120 lbs
Hair Color*
Eye Color*
Distinguishing Physical Characteristics*

if None - put N/A
Driver's License #*

if None, put N/A
Licensing State*

if None, put N/A
Vehicle(s) to be used for Door-to-Door Solicitations*
List Make, Model, Vehicle Identification Number (VIN), Tag Number and State for all Vehicles - if None, put N/A
Have you ever been convicted of a felony or misdemeanor*
- Yes
- No
If Yes, where and when were you convicted*

If No, put N/A
If Yes, what was the penalty/punishment*

if No, put N/A
Personal References - 2
List persons not related to you who will certify as to your good character and reputation
Reference #1
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email*
Reference #2
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email*
This form is now complete - you may hit submit. Thank you!
Comments
This field is for validation purposes and should be left unchanged.

Personal References - 2