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1 <br />For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br /> <br />LICENSE APPLICATION FOR - PEDDLERS AND CANVASSERS <br />MUNICIPAL CODE SECTION - 4-43 <br /> <br />I. APPLICATION TYPE Check One: New Renewal <br /> <br />II. BUSINESS DATA <br />A. Peddler's / Canvasser's Name: <br />B. Name of Business You Are Representing: <br />C. Business Mailing Address: <br />City: State: Zip: <br />D. Business Telephone Number: Fax Number <br />E. Business E-Mail Address: <br />F. Supervisors Name and Telephone Number: <br />G. Type of Goods, Wares, or Merchandise to be sold: <br /> <br />H. Proposed Dates of Operation: <br />I. Locations where Applicant intends to do business: <br /> <br />J. Peddling / Canvassing will take place (Check One): <br />On Foot: Pushcart: Wagon: Vehicle <br />If Vehicle, please provide: <br />Make and Model of Vehicle: <br />Vehicle license plate number and issuing state: <br />Vehicle Identification Number (VIN): <br />Driver's license number and issuing state: <br />K. Scales will be used in business transactions: Yes No <br />If yes, please attach certificate from the Sealer of Weights and Measures. <br /> <br />For Office Use Only <br /> <br />Application Filed License Fee Paid <br />Application Fee Paid License Number <br />Sent to Dept. Badge Number <br />Police Department Approval Metal Plate Number <br /> <br />Not Approved <br />Reason