Bensalem(Township(Amphitheater( Food(Vendor(Application

Bensalem(Township(Amphitheater(
Food(Vendor(Application(
Summer(2016(
Description(of(Event:(Outdoor(Concert(Series(Hosted(At(the(TD(Bank(Amphitheater(located(at(
Bensalem(Township’s(Central(Park,(2400(Byberry(Road,(Bensalem,(PA(19020(
(
Bensalem’s( TD( Bank( Amphitheater( hosts( concerts( every( Wednesday( evening( throughout( the(
season.(Vendors(are(permitted(on(the(grounds(1(hour(prior(to(general(admission(which(is(6:00(
P.M.( (therefore( 5:00( P.M.).( Vendors( may( access( the( park( via( a( private( drive( located( directly(
behind( the( Bensalem( Municipal( Building,( directly( off( Byberry( Road.( Look( for( the( sign( that(
states( “Talent( &( Crew( Entrance”.( ( You( will( be( asked( (at( times)( to( show( the( vending( license(
issued(by(Bensalem(Township.((
(
The$2016$Concert$Dates:$
(
June(1(
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(
July(6(/(NO(CONCERT(
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August(3(
June(8(
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July(13(
(
(
(
(
August(10(
June(15(
(
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(
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July(20(
(
(
(
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August(17(
June(22(
(
(
(
(
July(27(
(
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August(24(
June(29(
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(
(
(
(
(
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August(31(
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Vendor$Information$&$Requirements$(Please$read$carefully)$
(
Vendor(Space(Fee:((
$300( Per( Season( (Check,( Money( Order( or( Cash`No( Credit( Cards)(
Made(payable(to((
(
(
(
Bensalem(Township((
*Payment( is( due( with( application( along( with( Bensalem( Township’s( Application( for(
Solicitor/Peddler(License(and(completed(criminal(records(background(check.((
(
*The(Solicitor/Peddler(License(is(included(in(this(document,(and(requires(an(additional($25.00(
check(made(payable(to(Bensalem(Township(Building(&(Planning.((
(
*The( Pennsylvania( State( Police( criminal( records( fee( via( the( website( provided(
(https://epatch.state.pa.us)(is(an(additional($10.00.(Most(likely(a(credit(card(will(be(required(to(
process(the(background(check.((
(
VENDOR(FEES(ARE(NON`REFUNDABLE(
(
In( addition( to( the( licenses( indicated,( we( also( require( a( Certificate( of( Insurance,( naming(
Bensalem(Township(as(an(additional(insured.(This(is(a(common(practice.(
(
BENSALEM TOWNSHIP
Building and Planning Department
Office 215-633-3644 ▪ Fax 215-633-3753
2400 Byberry Road ▪ Bensalem, PA 19020
APPLICATION
Permit #
Date
Tax Parcel #
SOLICITOR/PEDDLER LICENSE
To the best of his/her knowledge, the undersigned certifies that the information contained in this application is true
and correct. The information is being furnished to make application for a license to solicit and/or peddle within the
Township of Bensalem, and applicant agrees to abide by all regulations set forth in the Township Ordinance.
1.
Applicant’s Full Name:
Social Security No.
Applicant’s Address
Phone No.
2.
Applicant’s Age:
Hair Color:
Date of Birth:
Eye Color:
Gender:
Male
Female
Race:
Driver’s License No.
3.
State Where Issued:
Has applicant ever been convicted or pleaded guilty to any crime?
YES
NO
If Yes,
Crime
4.
Date of Conviction-Plea
Location
Name of Employer:
Address of Employer:
Employer’s Phone No:
Employer is a :
Corporation
Partnership
Individual
Association
5.
Name of company for whom you are soliciting?
6.
Description of item for which you will be soliciting: (Service, Article, Device, Subscription, Contract, etc.)
NOTE: Applicant is required to apply for a criminal records check through the Pennsylvania State Police.
Copy and paste the link for the website to make this application. https://epatch.state.pa.us
OFFICE USE ONLY
APPROVED
DENIED
Director of Building & Planning
Date
Rev 4/2014