Tobyhanna Township
Monroe County, Pennsylvania
Application For Transient Retail Merchant License

Transient Retail Merchant Fee- $300.00 for eight days in one year, consecutively or separately

Due to a required signature, simply type in the required information, print and mail the form or application with fee to the Township offices.

Applicant/Solicitor Name


Mailing Address


Telephone Number


Name of Employer


Employer's Mailing Address


Employer's Telephone Number


Nature of Goods, Wares, Services or Merchandise to be offered for sale or solicited:



Method of Operation


Location of Solicitaion


Vehicle(s) To Be Used:


Date(s) of Solicitation Time of Solicitation

The Applicant/Solicitator Has Beeen Convicted of Any Felonies?
YesNo

"I Certify that the facts contained in the Permit are true and complete to the best of my knowledge and understand that, if approved, falsified statements on this permit shall be grounds for denial."

Name of Applicant

Signature of Applicant Tobyhanna's Township Peddlers Application

For Official Use Only

Date Application Was Received

Fee Paid Check#

Date Application was Approved

Approved By Title

Effective Date Expiration Date

Application Rejected By Title

Date Application was Rejected

License #

Please Note: Hours of solicitation is 8:00 am to 8:00pm EST

CC: Tobyhanna Township Police Dept.

Rev. 10/06