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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*
31. Upload copy of Drivers License*
35. Vehicle Make*
36. Vehicle Year*
37. Vehicle Color*
39. Vehicle License Number*
40. Vehicle License State*
44. Description of Solicitation Activity*
46. Company Name*
47. Company Phone Number*
49. Company Address*
50. City*
51. Zip*
52. State*
54. Length of Employment*
55. Supervisor Name*
59. Has the Applicant been issued a Hanover Park Solicitor Permit previously?*

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 Has the Applicant’s Hanover Park Solicitor Permit ever been revoked?*

    1. Yes
    2. No
63. Provide Details
65. 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
66. Provide Details
70. Start Date of Solicitation*
    Start Date of Solicitation
71. End Date of Solicitation*
    End Date of Solicitation
72. Area of Solicitation*
76. 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.
78. 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.

79. Today's Date*
    Today's Date

81. Thank you for your submission it will ONLY be processed once payment has been made. We will respond to your inquiry as soon as we have the payment.  
    Please watch for an email in the coming days to set up a time for finger printing at our Police Department and further instructions. For additional information, please contact our office. 

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83. 1. Receive an email copy of this form.
84. Email address

    This field is not part of the form submission.

85. Submit Submit and Print

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