Mobile Food Vendor; Peddler; Canvasser; Solicitor or Transient Merchant Business License Application

Town of Payson

Finance Department 303 North Beeline Hwy, Payson, AZ. 85541

Phone (928) 472-5007 FAX (928) 472-7628

Applicants with disabilities

Applicants with disabilities may contact the Finance Department to coordinate via telephone, e-mail, and other means to request and arrange for accommodations. If you need assistance to accommodate a disability, you may request an accommodation at any time. Please contact the Finance Department at Phone: (928)472-5007 or email at [email protected]. TDD phone number is 928-472-6449.

Arizona State ID

Health Permit (if handling food)

Proof of a $500 Permit bond

Fingerprints or clearance card

Gila County Health Departments

TPT

Fingerprint

Welcome

The Town of Payson staff would like to thank you for applying for your Business License. The Town of Payson is responsible for issuing business licenses for all business activities within the Town limits. All persons doing business in the Town of Payson are required to have a Town issued Business License, unless they are exempt by the Payson Town Code. Please see website; www.paysonaz.gov; Quick Links; Town Code Search; Chapter 110 for Town Code Business Licensing. All fees are non-refundable.

Next Steps Once Application is complete

Once a completed application has been received and fees have been paid, the review process will begin. We may request additional information in order to complete the approval process.

Applicant Name *

First

Last

Date

Name of Business / Organization *

Doing Business As (DBA): *

If none/same use "NA"

AZ State License No. (Sales tax-TPT)

Business Phone Number: *

Goods Sold *

Primary Name *

First

Last

Primary Contact Email: *

Cell Phone *

Business Address *

Address Line 1

Address Line 2

City

State

Zip Code

If your business and home address are the same, your address becomes a public record. If you want your home address to not be made public, please consider getting a PO Box for your business address.

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

If your business and home address are the same, your address becomes a public record. If you want your home address to not be made public, please consider getting a PO Box for your business address.

Date of Birth *//

Place of Birth: *

Sex *

Height: *

Weight: *

Eye Color: *

Hair Color: *

Nature of Business Description: *

Description of vehicle(s) to be used: *

License numbers of all vehicles to be used: *

Have you ever been convicted of a crime, misdemeanor (other than minor traffic violations) or violations of any municipal laws? *

References

Name at least two reliable property owners of the Town of Payson who will verify applicant’s good character and business responsibility:

Name #1 *

First

Last

Phone #1 *

Name #2 *

First

Last

Phone #2 *

Fingerprint Notification And Disclosure

Your fingerprints will be used to check the criminal history records of the FBI. If you have a criminal history record, the officials making a determination of your suitability for a Business License must provide you the opportunity to challenge the accuracy of the information in the record. The procedures for obtaining a change, correction, or updating an FBI criminal history record are set forth in Title 28, Code of Federal Regulations (CFR), and Section’s 16.30 through 16.34. Information on how to review and challenge an FBI criminal history record can be found at www.fbi.gov under "Services: and then "Identity History Summary Checks" or by calling (304) 625-5590. To obtain a copy of your Arizona criminal history in order to review, update or correct the record, you can contact the Arizona Department of Public Safety Criminal History Records Unit at (602) 223-2222 to obtain a fingerprint card and a Review and Challenge packet. Information on the review and challenge process can be found on the DPS website (www.azdps.gov).

Terms of Electronica Signature *

I have read and agree to the terms of service listed below.

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Date *

Signature *

State/Federal Government Issued ID *

Click or drag files to this area to upload. You can upload up to 2 files.

Front and back of ID.

Clearance Card

Click or drag files to this area to upload. You can upload up to 2 files.

Front and back of clearance card.

Other Supporting Docs./ Health Permit

Click or drag a file to this area to upload.

Authorization for Background Check

I hereby authorize the obtaining of ''consumer reports" by The Town of Payson at any time after receipt of this authorization. I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by the Town of Payson Police Department. I also consent to have any legally required notices sent electronically.

Signature *

Terms of Service *

I have read and agree to the terms of service listed below.

I understand that a Business Occupancy Permit and a Business License must be issued before I can lawfully engage in business in the Town of Payson. Pursuant to A.R.S. § 13-2704, a person commits unsworn falsification by knowingly making any statement that he or she believes to be false, in regard to material issue, to a public servant in connection with an application for any license and such unsworn falsification is a class 2 misdemeanor. Pursuant to A.R.S. § 41-1080 , the Town shall not issue a license to an individual if the individual does not provide documentation that his or her presence in the United States is authorized under federal law. By my signature below, I hereby Attest and Certify that the statements and information provided in the application for a license are true and correct and are knowingly made under the penalty provided by A.R.S. § 13-2704 and have provided documents in compliance with A.R.S. § 41-1080.I understand that a Business Occupancy Permit and a Business License must be issued before I can lawfully engage in business in the Town of Payson. Pursuant to A.R.S. § 13-2704, a person commits unsworn falsification by knowingly making any statement that he or she believes to be false, in regard to material issue, to a public servant in connection with an application for any license and such unsworn falsification is a class 2 misdemeanor. Pursuant to A.R.S. § 41-1080 , the Town shall not issue a license to an individual if the individual does not provide documentation that his or her presence in the United States is authorized under federal law. By my signature below, I hereby Attest and Certify that the statements and information provided in the application for a license are true and correct and are knowingly made under the penalty provided by A.R.S. § 13-2704 and have provided documents in compliance with A.R.S. § 41-1080.

Date *

3. Do you have workers compensation insurance? *

4. Is your business required to have a state license? *

TOWN OF PAYSON AFFIDAVIT *

I have read and agree to the terms of service listed below.

I have reviewed the records of the listed business and I make this affidavit on behalf of the business named on this application.
Based upon such review, to the best of my knowledge, information, and belief, all of the above listed business's employees
currently working in Payson are United States citizens, permanent resident aliens, or persons otherwise lawfully in the U.S.
For the purposes of this affidavit, the term `employee' means all persons for which the above listed business is required to
fill out an I9 form pursuant to Federal Law.

Terms of Electronica Signature *

I have read and agree to the terms of service listed below.

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Signature *