ITENERANT VENDOR PERMIT APPLICATION Not Valid During Homecoming CITY OF GRAMBLING 127 King Street Grambling, LA 71245 Telephone (318) 247-6120 Fax: (318) 247-0940

Week, Juneteenth Festival, and Designated Special Events. Additional Permit Required.

APPLICANT INFORMATION Name: ____________________________ Title:____________________ Email: __________________________ Cell #: ____________ Address:____________________________ City: _________________ State: ____ Zip:______ Phone #: __________ Fax#: __________

BUSINESS INFORMATION Trade Name: ______________________________ Legal Name: _____________________________________ Business Location/Address:____________________________________________ Grambling, Louisiana Mailing Address:______________________________________ City: __________________ State: _____________ Zip:____________ Phone #: __________ Fax#: __________ Website: __________________________ State of Incorporation/organization: ____________ Type of Business: □ Sole Proprietorship □ Partnership □ Corporation □ LLC □ Non- Profit □ Other __________________ FEIN/SS#_________________________ LA. Sales Tax #_______________ Local Sales Tax #______________ Name & Address of Agent for Service of Process:________________________________________________________________________ Liability Insurance Carrier ____________________Policy Number__________________ Expiration Date ______ Policy limits__________

BUSINESS OWNER/OFFICER INFORMATION Name:_______________________ Title:____________________ Address:________________ City:_________ State:___ Zip:_____ Phone #:____________ Cell #: ___________ Fax#: ___________ Email: _______________________________________________

Name: _______________________ Title:____________________ Address:_______________ City: _________ State: ___ Zip:_____ Phone #: ____________ Cell#: ____________ Fax#: ___________ Email: _________________________________________________

PRODUCT SALES INFORMATION Describe the type of products and items to be sold. _________________________________________________________________________ __________________________________________________________________________________________________________________

PROPOSED BUSINESS TYPE AND LOCATION □ Door to Door □ Fixed Location with Property Owner Consent: __________________________________________________________________________ □ Fixed Location on Public Property with Written Approval: ________________________________________________________________ □ Other:__________________________________________________________________________________________________________

AUTHORIZED SALES REPRESENTATIVES/EMPLOYEES Name:____________________________ Title:_________________ Cell#:____________ Address:__________________________________ Name:____________________________ Title:_________________ Cell#:____________ Address:__________________________________ (Employees must work at same location at same time. Permit does authorize separate locations for multiple employees)

CERTIFICATION Applicant swears the statements made on this application and attachments are true and correct to the best of his/her knowledge. I acknowledge that other licenses or permits may be required to legally conduct business in the City of Grambling. I understand that I must report any change in business ownership, operation, and/or address immediately. _______________________________ __________________________________ _________________ Signature Printed Name Date

OFFICIAL USE ONLY Date App. Rec’d __________ Fees Rec’d _______ Approved by: ____________________________________________________ Received Copies of: □ La. Secretary of State Certificate/Registration □ Lincoln Parish and Use Tax Comm. Registration Certificate □ Liability Insurance Certificate □ Permission of Property Owner, if applicable □ Written Agreement with Public entity, if applicable

ANNUAL PERMIT FEES: $200.00 Itinerant Vendor Permits expire December 31st each year