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2. Applicant Name*
3. Applicant Email*
5. Applicant Street Address*
6. City*
7. Zip*
8. State*
10. Length of Residency*
11. Applicant Phone Number*
15. Address during past 3 years*
16. City*
17. Zip*
18. State*
22. Date of Birth*
    Date of Birth
23. Driver's License Number*
24. Driver's License State*
26. Height*
27. Weight*
28. Hair Color*
29. Eye Color*
33. Vehicle Make*
34. Vehicle Year*
35. Vehicle Color*
37. Vehicle License Number*
38. Vehicle License State*
42. Description of Solicitation Activity*
44. Company Name*
45. Company Phone Number*
47. Company Address*
48. City*
49. Zip*
50. State*
52. Length of Employment*
53. Supervisor Name*
57. Has the Applicant been issued a Hanover Park Solicitor Permit previously?*

    1. Yes
    2. No
58. Provide Details
60. Has the Applicant’s Hanover Park Solicitor Permit ever been revoked?*

    1. Yes
    2. No
61. Provide Details
63. Has the Applicant ever been convicted of the commission of a felony under the laws of the State of Illinois or any other State or Federal law of misconduct which constitutes a Class A Misdemeanor under Illinois law?*

    1. Yes
    2. No
64. Provide Details
68. Start Date of Solicitation*
    Start Date of Solicitation
69. End Date of Solicitation*
    End Date of Solicitation
70. Area of Solicitation*
74. I AFFIRM THAT THE INFORMATION PROVIDED IS TRUTHFUL. I ALSO UNDERSTAND THAT THE APPROVED STATUS OF THE ISSUED PERMIT IS DEPENPENDENT UPON COMPLIANCE WITH ALL VILLAGE ORDINANCES WHILE THIS PERMIT IS IN EFFECT.
76. Name*

    DISCLAIMER: By typing your name here, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

77. Today's Date*
    Today's Date
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79. 1. Receive an email copy of this form.
80. Email address

    This field is not part of the form submission.

81. Submit Submit and Print

* indicates a required field