Cobb County Business License Division

Door To Door Salesperson Permit Application

5/15/15

C:\Users\hugheb034777\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\JIKEQ9V9\DOOR TO DOOR APP 2016.doc

Cobb County

Business License Division

P.O. Box 649

Marietta, Georgia 30061-0649

Phone 770-528-8410

If you wish for this application to be hand delivered or

delivered via UPS or FedEx please do so at:

1150 Powder Springs Street, Suite 400

Marietta, Georgia 30064

DOOR TO DOOR SALES

The following are guidelines for persons going door to door to sell a product in Cobb County. A permit is not required to communicate to

the resident for religious, charitable or political purposes. These guidelines are not the Code of Ordinance nor should they be substituted for

the Code of Ordinance.

1. All individuals going door to door selling products in residential areas in Cobb County must register and obtain the appropriate

badge through the Cobb County Business License Division.

2. Each person going door to door in residential areas selling products must possess a picture identification badge issued by the Cobb

County Business License Division prior to soliciting in the county. Completion of the door to door sale permit application and

payment of the prescribed fee and issuance of a receipt does not authorize the applicant to operate in Cobb County. Only the

issuance of a door to door sales permit badge by the Cobb County Business License Division authorizes the individual to go door

to door in unincorporated areas of Cobb County.

3. All applicants requiring badges issued by the County shall provide two 1 1/4 x 1 1/4 pictures with the application that will be

utilized for identification purposes to ensure the appropriate individual is authorized to go door to door in Cobb County.

4. The badge shall be worn by the individual going door to door in a conspicuous place that can be seen by the home occupant. Any

other unapproved type of identification cannot be substituted for the Cobb County Door to Door Salesperson Badge. All badges

will have a picture of the applicant, name of the organization represented, address of the organization, name of the applicant,

phone number of the organization.

5. A door to door sales permit does not authorize the sale of the product in the right of way of any road or highway or in commercial

areas.

6. Any alteration, duplication or misrepresentation of the Cobb County door to door badge shall subject the individual and/or

company that the individual represents, to penalties as provided by law.

7. The permit is valid for ninety days.

8. No persons may contact citizens door to door before 9:00 a.m. or after 9:00 p.m. No door to door salesperson shall contact

persons or residents where the residence has posted “No Soliciting ”or in a neighborhood/subdivision on private roads/streets and

a “No Soliciting” sign is posted.

9. Failure to abide by any of the above guidelines and the Cobb County Code of Ordinance will subject the violator to possible

criminal prosecution and/or suspension and/or revocation of the door to door salesperson permit.

10. An Occupation Tax Certificates is required in addition to a door to door salesperson permit.

11. The payment of the $55 non-refundable fee for the permit is due upon issuance of the permit in addition to any occupation

Cobb County Business License Division

Door To Door Salesperson Permit Application

5/15/15

C:\Users\hugheb034777\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\JIKEQ9V9\DOOR TO DOOR APP 2016.doc

Cobb County

Business License Division

P.O. Box 649

Marietta, Georgia 30061-0649

Phone 770-528-8410

Application for Door-To-Door Sales Person Permit

Date: ___/___/___ PERMIT # _________________ PERMIT VALID FROM ___/___/___TO___/___/___

1. Name of applicant: __________________________________________Phone: ________________

2. Date of birth: ______/_____/_____ Place of Birth: ________________________________

3. Social Security # : _____-____-_____ Sex: _____ Race: ___________

4. Home address: __________________________City: _____________State: ________Zip:_______

5. Mailing address: _________________________City: _____________State: ________Zip:_______

6. Email address: ________________________________________________

7. Previous home address last three years________________________________________________

8. Company Name: ___________________________________________Phone:__________________

Company Address: _______________________City: ______________State: ________Zip:_______

Company Contact: ___________________________________ Phone:_________________________

9. Name of local supervisor: ____________________________________Phone:__________________

Supervisors Address:____________________ City:_______________ State: _________Zip:_______

10. Type of product to be sold___________________________________________________________

11. Have you ever been issued a citation, arrested, convicted or entered a plea of nolo contendere

prior to the filing of this application for any felony or misdemeanor of any state

or of the United States or for any municipal ordinance (this includes traffic violations)? Yes ( ) No ( )

If answer is yes, describe in detail and provide dates: _____________________________________

_________________________________________________________________________________

12. Are you familiar with Cobb County Ordinance governing the operation of door-to-door sales?

Yes ( ) No ( ) Do you agree to abide with such ordinances and regulations? Yes ( ) No ( )

I affirm that the facts stated by me are true, I understand that any misrepresentation or fraudulent statement is

grounds for automatic dismissal of this application and or revocation of permit.

I hereby authorize the Cobb County Business License Division to receive any criminal history record information

pertaining

___________________________________ _________________________________

Signature of Applicant Date Notary Public Date

Cobb County Business License Division

Door To Door Salesperson Permit Application

5/15/15

C:\Users\hugheb034777\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\JIKEQ9V9\DOOR TO DOOR APP 2016.doc

CONSENT FORM

I HEREBY AUTHORIZE COBB COUNTY BUSINESS LICENSE TO RECEIVE ANY CRIMINAL HISTORY

RECORD INFORMATION PERTAINING TO ME WHICH MAY BE IN THE FILES OF ANY STATE OR LOCAL

CRIMINAL JUSTICE AGENCY IN GEORGIA.

____________________________________

FULL NAME PRINTED

____________________________________

STREET ADDRESS

____________________________________

CITY, STATE, & ZIP

_________ _________ ____________________ ______________

SEX RACE DATE OF BIRTH SS NUMBER

____________________________________

ALIEN NUMBER (IF NOT A US CITIZEN)

____________________________________

SIGNATURE

____________________________ _______________________

NOTARY PUBLIC DATE

Cobb County Business License Division

Door To Door Salesperson Permit Application

5/15/15

C:\Users\hugheb034777\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\JIKEQ9V9\DOOR TO DOOR APP 2016.doc

O.C.G.A. § 50-36-1(e)(2) Affidavit

By executing this affidavit under oath, as an applicant for a Business License / Occupational Tax Certificate as

referenced in O.C.G.A. § 50-36-1, from Cobb County the undersigned applicant verifies one of the following with

respect to my application for public benefit:

CHECK ONE:

1)____I am a United States citizen.

2)____ I am a legal permanent resident of the United States. (Provide I-551)

3)____ I am a qualified alien or non-immigrant under the Federal Immigration and Nationality

Act with an alien number issued by the Department of Homeland Security or other federal immigration agency.

My alien number issued by the Department of Homeland Security or other federal immigration agency is:

_________________________________________________.

The undersigned applicant also herby verifies that he or she is 18 years of age or older and has provided at least one

secure and verifiable document, as required by O.C.G.A § 50-36-1(e)(1), with this affidavit.

The secure and verifiable document provided with this affidavit can best be classified as:

________________________________________________________________________.

In making the above representation under oath, I understand that any person who knowingly and willfully makes a false,

fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20,

and face criminal penalties as allowed by such criminal statute.

Executed in ______________________________(city), ____________________________(state).

__________________________________

Signature of Applicant

____________________________________

Printed Name of Applicant

____________________________________

Applicant Phone Number

SUBSCRIBED AND SWORN

BEFORE ME ON THE

_____DAY OF____________20___

______________________________

NOTARY PUBLIC

My Commission Expires:

Business Name ________________________________________________________

Occupation Tax Certificate /License #______________________________________

Cobb County Business License Division

Door To Door Salesperson Permit Application

5/15/15

C:\Users\hugheb034777\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\JIKEQ9V9\DOOR TO DOOR APP 2016.doc

MUST COMPLETE THIS FORM IF YOU HAVE 10 OR LESS EMPLOYEES

Business Name ______________________ License #/Occupation Tax #___________

NUMBER OF EMPLOYEES (COMPANY WIDE) _________ (Required for 10 OR LESS EMPLOYEES)

Private Employer Exemption Affidavit Pursuant To O.C.G.A. § 36-60-6(d)

By executing this affidavit, the undersigned private employer verifies that it is exempt from

compliance with O.C.G.A. § 36-60-6, stating affirmatively that the individual, firm, or corporation

employs ten (10) or fewer employees and is not required to register with and/or utilize the federal

work authorization program commonly known as E-Verify, or any subsequent replacement program,

in accordance with the applicable provisions and deadlines established in O.C.G.A. § 36-60-6.

I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on ______________, ___, 20___, in _________________ (city), ______ (state).

__________________________________________

Printed Name of Exempt Private Employer

__________________________________________

Signature of Exempt Private Employer or

Authorized Officer or Agent

___________________________________________

Printed Name and Title of Person Executing Affidavit

SUBSCRIBED AND SWORN BEFORE ME ON

THIS THE ______ DAY OF __________, 20___.

_____________________________________

NOTARY PUBLIC

My Commission Expires: _________________

Cobb County Business License Division

Door To Door Salesperson Permit Application

5/15/15

C:\Users\hugheb034777\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\JIKEQ9V9\DOOR TO DOOR APP 2016.doc

MUST COMPLETE THIS FORM IF YOU HAVE 11 OR MORE EMPLOYEES

Business Name _______________________ License #/Occupation Tax #_____________

NUMBER OF EMPLOYEES (COMPANY-WIDE) : _________ (Required for 11 OR MORE EMPLOYEES)

Private Employer Affidavit Of Compliance Pursuant To O.C.G.A. § 36-60-6(d)

By executing this affidavit, the undersigned private employer verifies its

compliance with O.C.G.A. § 36-60-6, stating affirmatively that the individual, firm or

corporation has registered with and utilizes the federal work authorization program

commonly known as E-Verify, or any subsequent replacement program, in accordance

with the applicable provisions and deadlines established in O.C.G.A. § 36-60-6.

Furthermore, the undersigned private employer hereby attests that its federal work

authorization user identification number and date of authorization are as follows:

_________________________________

Federal Work Authorization User Identification Number (Also known as E-Verify number)

(An E-Verify number is four to six characters – it is not your Federal ID Number)

_________________________________

Date of Authorization

_________________________________

Name of Private Employer

I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on _______________, 20____ in __________________ (city), ______ (state).

__________________________________________

Signature of Authorized Officer or Agent

__________________________________________

Printed Name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME

ON THIS THE ______ DAY OF __________, 20___.

_________________________________________

NOTARY PUBLIC

My Commission Expires: _____________________