St. Louis County Department of Revenue – Division of Licenses 41 S. Central Avenue, Clayton, MO 63105 – P: 314/615-4217, F: 314/615-5125 Licensing@stlouiscountymo.gov Application for STREET VENDOR License as defined by Chapter 812, Saint Louis County Revised Ordinances __________________________________________________________________________________________________ Legal Name of Applicant (First, MI, Last) __________________________________________________________________________________________________ Permanent Street Address, City, State, Zip Code (NO PO Box Number) ____________________________________________ Cell/Home Phone with Area Code
_________________________________________________ Email
Registered Agent with Secretary of State
Yes - Name: ________________________________________
No
__________________________________________________________________________________________________ Name and Address of St. Louis Business Represented ____________________________________________ Business Phone with Area Code
____________________________________________________ Business Email/Website
List all employees who will be vending: 1. ___________________________________________________________________________________________ 2. ___________________________________________________________________________________________ 3. ___________________________________________________________________________________________ 4. ___________________________________________________________________________________________ 5. ___________________________________________________________________________________________
Describe your operation (e.g. I will be selling snow cones): _________________________________________________ __________________________________________________________________________________________________ Year, make and model of your vehicle: __________________________________________________________________
Area of St. Louis County where you are vending, including intersection, date & time (if applicable): __________________________________________________________________________________________________ __________________________________________________________________________________________________
I certify that the information contained in this application and its attachments is true, correct, and complete to the best of my knowledge. I understand that any misstatement of material facts herein is cause for suspension or revocation of this license. _________________________________________________________________________ Printed Name of Applicant (including title if applicable) _________________________________________________________________________ Signature of Applicant (including title if applicable)
Revised 09/2021
_______________________ Date