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2. 
4. Please reference Ordinance 1017 for any questions or requests for elaboration where it pertains to a solicitors permit.
8. Section 1: Company or Entity Information
   The legal business name is the name that will appear on the license and is the actual name under which the contracting business will operate. The full business name must be provided.
10. Company or Entity Name*
12. Physical Address*
14. City*
15. State*
16. Zip Code*
18. Phone Number*
19. Fax Number
23. Section 2: Contact Person Information
    Provide information for a point of contact that can be reached in regards to this application.
25. Contact Name*
27. Mailing Address*
29. City*
30. State*
31. Zip Code*
33. Phone Number*
34. Fax Number
36. Email Address*
38. Title Within the Organization or Entity*
42. Section 3: Solicitors Information
    Provide information regarding the individuals who will be soliciting within the Village of Elwood.
44. Solicitor #1: Name*
46. Phone Number*
47. Birthday*
49. General Description
53. Solicitor #2: Name
55. Phone Number
56. Birthday
58. General Description
62. Solicitor #3: Name
64. Phone Number
65. Birthday
67. General Description
71. Solicitor #4: Name
73. Phone Number
74. Birthday
76. General Description
78. Only four solicitors are allowed per application.
    If more than four individuals will be soliciting, please fill out an additional form with their information.
82. Section 4: Conditions of Solicitors Permit
    Review and understand the conditions associated with issuance of this solicitors permit.
84. An approved high visibility vest must be worn at all times by all individuals involved in the soliciting activity(ies) approved in this permit.*

    1. I understand and will comply with the above statement.
86. All solicitors must be a minimum age of 16 years old as of the date of this application.*

    1. I understand and will comply with the above statement.
88. Once authorized to solicit under a permit, the company must publish in a newspaper of general circulation, within the Village, a notice to the public stating the intention to solicit and the authorized date of solicitation.*

    1. I understand and will comply with the above statement.
90. The following limits on solicitors permits apply:*

    1. I understand and will comply with the below statement.

    1) No organization shall conduct more than one solicitation day per calendar year within the Village. 2) No more than one organization shall be permitted to solicit on a given day. 3) Permits shall authorize solicitation only between 9:00 AM and 8:00 PM. 4) No permit shall authorize solicitation on a Sunday, legal holiday, or within 48-hours of a legal holiday.
92. The permit is not to be issued any earlier than three business days after the completed application is submitted.*

    1. I undersand and will comply with the above statement.
94. The applicant must comply with all conditions of Ordinance 1017.*

    1. I understand and will comply with the above statement.
98. Section 5: Fee and Insurance Requirements
    Check with your insurance carrier to ensure you are properly covered.
100. The Village of Elwood must be listed as a Certificate Holder and issued a valid Certificate of Liability Insurance.*

     1. I have read and understand the Insurance Requirements.

     The Applicant must obtain insurance providing coverage for bodily injury ability in the amount of one hundred thousand dollars ($100,000) for any individual and three hundred thousand dollars ($300,000) for any occurrence and for property damage liability in the amount of one hundred thousand dollars ($100,000). Said policy shall name the Village of Elwood as a certificate holder.
102. Indicate Payment Method:*

     1. Check
     2. Credit Card
     3. Cash

     Solicitor permit requires a payment of the current registration fee in the amount of $50. Please see the 'Information' section below for details on where to submit payment.
104. Information
     Please submit any additional information, attachments or payment by phone to (815) 423-5011, by fax to (815) 423-6861, by email to julie.friebele@villageofelwood.com or by mail to Village of Elwood, 401 East Mississippi Avenue, Elwood, IL 60421.
108. Section 6: Application Conditions with Signature
     Read through the application thoroughly and understand the Village of Elwood ordinances and permit requirements.
110. Conditions
     In consideration of this application and attached forms being made a part thereof, the applicant will conform to the regulations set forth in the Village of Elwood codes and ordinances. The applicant's signature below indicates the information contained in this application and on any accompanying documents is true and correct. This is to certify, I am authorized to renew/apply for this license on behalf of any other owner(s) of the licensed entity and that all owners/officers/partners/members/qualifying agents are aware of the following: -All information and attachments, including financial statement(s) for the licensed entity is true and correct. -The Village of Elwood may refuse to renew a license for lack of insurance. I do hereby state under oath that I will not violate any of the Village of Elwood ordinances in the conduct of my/our business. Furthermore, I state that I understand the Village of Elwood's building codes, inspection requirements and conduct of business regulations.
112. Electronic Signature*
     By providing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.
113. Date*
     Date
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117. Submit Submit and Print

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