Peddler’s License Application

Refund of the cash bond may be requested 4 months after expiration of license.

Please fill out a new application for each Applicant/Employee, even if for the same business. Fees will be assessed and the total will be emailed to the applicant within the 3-day waiting period. Fees will be required to be paid before the license(s) are approved. Payment may be made by mailing in a check to City Hall or coming into City Hall to pay in person.

Peddler's License Application

For any questions, please contact City Administrative Clerk Sarah Hauser at shauser@adeliowa.org or by calling City Hall at (515) 993-4525.

"*" indicates required fields

Time Period of License/Fee Amount:*

One Day License: $50 (+$25/additional person)

One Week License: $75 (+$25/additional person)

6 Month License: $275 (+$25/additional person)

1 Year License: $525 (+$25/additional person)

Date(s) that this license is requested for:*

Applicant/Employee Information

Name*

First Last

Phone Number*

Email Address*

Permanent Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Local Address*

(Hotel/Motel specify)

Street Address Address Line 2 City State ZIP Code

Social Security Number*

Age*

Height*

Weight*

Hair Color*

Eye Color*

Business/Employer Information

Business/Employer Name*

Nature of Business*

(Be specific)

Business Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer's Phone*

Employer's Email*

Federal Tax ID Number*

Iowa Sales Tax Permit Number

If no Iowa Sales Tax Permit Number, attach letter from Department of Revenue

Max. file size: 2 MB.

Background Information

List last 3 Cities/States where business has been conducted:

Date range of previous Adel license issued:

Have you been listed on a Sex Offender Registry within the last 5 years?*

Has your Solicitor's License been suspended/revoked within the last 5 years?*

If yes, attach a separate sheet stating reasons:*

Max. file size: 2 MB.

Please upload a photo of a Government Issued Photo ID:*

Max. file size: 2 MB.

Criminal History Background Check dated within the last 30 days:

If you do not have a Criminal History Background Check within the last 30 days, please download the request from the link you will find on the confirmation page and submit via email to cityhall@adeliowa.org.

Max. file size: 2 MB.

If you are driving a vehicle, provide a description including color, make, and model:

License plate number:

Consent Fields

Signature of Applicant*

NOTE: This license is not transferable to any other person(s) and may be revoked if provision of the City Code are violated.

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