Solicitor License

2. 

4. 807 Mountain Avenue | PO Box 1229 | Berthoud, CO 80513 | O: 970-344-5801 | E: deputyclerk@berthoud.org

6. Date of Application:
   Date of Application:

8. Refer to Berthoud Municipal Code  14.6-1(c) and 14.6-5

   License Fee: $250.00 

   Also must have a $500.00 Surety Bond

   Payment and Surety Bond can be submitted to the Town of Berthoud at 807 Mountain Avenue; Berthoud, CO 80513

   
   

   The license expires every year on December 31.

10. Company Name:
11. Email Address
13. Address
15. City
16. State
17. Zip Code
19. Phone Number
21. Registered Agent:
23. Date of Birth
    Date of Birth
25. Name
26. Email Address
28. Residential Address:
30. City
31. State
32. Zip Code

34. Fill in the information below for all persons soliciting for the above-named business.  Attach an additional sheet if there are not enough lines provided.  

    Each person soliciting must complete a release form for a background check.

35. Background Check Authorization Form

    Background Check Authorization Form

36. Submit your Background check authorization.*

    Each person soliciting must submit authorization for a background check.

38. 1. Name
39. Driver License State and Number
40. Date of Birth
    Date of Birth
42. Address
44. City
45. State
46. Zip Code
48. Phone Number
50. 2. Name
51. Driver License State and Number
52. Date of Birth
    Date of Birth
54. Address
56. City
57. State
58. Zip Code
60. Phone Number
62. 3. Name
63. Driver License State and Number
64. Date of Birth
    Date of Birth
66. Address
68. City
69. State
70. Zip Code
72. Phone Number
74. 4. Name
75. Driver License State and Number
76. Date of Birth
    Date of Birth
78. Address
80. City
81. State
82. Zip Code
84. Phone Number

86. Name three towns or cities in which the applicant has been engaged in business within thirty days preceding the date of application. (Towns where a license was obtained.)

88. 1.
90. 2.
92. 3.
Leave This Blank:


94. 1. Receive an email copy of this form.
95. Email address

    This field is not part of the form submission.

96. Submit Submit and Print

* indicates a required field