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2. Fee: $20.00 - Payment can be made online or mailed/dropped off at 221 E Cottage Grove Rd, Cottage Grove, WI 53527.
3. Online Payment
   Online Payment
5. Dates of Activity (shall not exceed one year):*
7. Please select type of permit you are applying for:
   -- Select One --CanvesserTransient Merchant
9. Transient Merchant/Canvasser Information
11. Name:*
13. Home Address:*
15. Email:*
17. Date of Birth:*
18. Phone:*
20. Driver’s License Number & State (Please provide copy):*
22. Location(s) in the Village of operations:
24. Brief description of the nature of business or organization:
26. If applicable, describe the source of supply of the goods or merchandise proposed to be sold, a statement as to where such goods or merchandise are located at the time of submitting this application, and the proposed method of delivery.
28. Business or Organization Information:
30. Name:*
32. Address:*
34. Name of Supervisor/Manager:*
36. Phone:*
38. If the applicant is an employee of a business or organization, attach proof of employment with the business or organization to this application.
40. Last three municipalities which you conducted business (include name of business and contact name and phone number):*
42. Have you ever been convicted of any criminal or municipal ordinance offense? If yes, please list all prior convictions below. *
44. Provide the names and contact information for two Dane County property owners who will certify as to the applicant's good character and business respectability. In lieu of such names, the applicant may supply such other evidence that will enable the Village to properly evaluate the character and business responsibility of the applicant.*
46. Provide two recent frontal photographs of the applicant showing the applicant’s face & shoulders.*
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field