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Mountain Home Community Center

Sales ID Permit Application

City of Mountain Home logo

Mountain Home Planning & Engineering License #________

720 S. Hickory Expires: _________

Mountain Home, AR, 72653 Amt Pd: _________

Phone: (870) 425-2550 Receipt# _________

[email protected]

[{"type":"paragraph","subtype":"p","label":"A COPY OF YOUR VALID DRIVERS LICENSE AND SOCIAL SECURITY CARD IS REQUIRED.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"text","required":true,"label":"Name:","name":"Name","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Age:","name":"Age","className":"col-lg-4","subtype":"text"},{"type":"date","required":true,"label":"Date of Birth:","name":"Date-of-Birth","className":"col-lg-4"},{"type":"text","required":true,"label":"Home Address:","name":"Home-Address","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Home Phone:","name":"Home-Phone","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Vehicle Make/Model:","name":"Vehicle-MakeModel","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Vehicle Year:","name":"Vehicle-Year","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"Vehicle Color:","name":"Vehicle-Color","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"License Plate #:","name":"License-Plate-","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Driver's License #:","name":"Drivers-License-","className":"col-lg-4","subtype":"text"},{"type":"date","required":true,"label":"Driver's License Expiration Date:","name":"Drivers-License-Expiration-Date","className":"col-lg-4"},{"type":"text","required":true,"label":"Items offered for sale OR work offered:","name":"Items-offered-for-sale-OR-work-offered","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"IF WORKING FOR A COMPANY:","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"text","required":true,"label":"Name of Company Represented:","name":"Name-of-Company-Represented","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"Headquarters Office Address:","name":"Headquarters-Office-Address","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"Supervisor/Manager Name:","name":"SupervisorManager-Name","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Supervisor/Manager Phone #:","name":"SupervisorManager-Phone-","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"I, the above-names applicant, do wish to conduct a sales campaign within the city limits of Mountain Home, Arkansas.  I understand that any illegal sales practices may result in my arrest.<div><br></div><div>A Peddler Identification Card is required for each salesperson and can be obtained from the Mountain Home Police Department located at 650 SOUTH ST (870-425-6336).</div><div><br></div><div>There will be a $25.00 fee for each I.D.</div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"text","required":true,"label":"Applicant Signature-Typing your name serves as your signature:","name":"Applicant-Signature-Typing-your-name-serves-as-your-signature","className":"col-md-6","subtype":"text"},{"type":"date","required":true,"label":"Date Signed:","name":"Date-Signed","className":"col-md-6"},{"type":"text","label":"Police Department Verification:","name":"Police-Department-Verification","className":"col-md-6","subtype":"text"},{"type":"date","label":"Police Department Date Signed:","name":"Police-Department-Date-Signed","className":"col-md-6"},{"type":"text","label":"Jeannie Anderson Office Manager:","name":"Jeannie-Anderson-Office-Manager","className":"col-md-6","subtype":"text"},{"type":"date","label":"Office Manage Date Signed:","name":"Office-Manage-Date-Signed","className":"col-md-6"}]