SOLICITATION PERMIT APPLICATION

ROANOKE COUNTY, VIRGINIA

This application is for use by charitable, non-profit organizations applying to Roanoke County for a permit to solicit or cause a solicitation to be made within Roanoke County.  Please answer all questions. All fields are required.

For more information please call 540-772-2005 or email. 

Applicant Information

1.  Applicant Name:
(Person submitting request. Provide name of organization in Question #5.)

2.  Applicant  Street Address: 

City:  State:   Zip Code: 

3.  Area Code:     Phone Number     

Email Address:

Event Information

4.  Dates on which solicitation will begin and end (NOT TO EXCEED 90 DAYS AND TO BE CONDUCTED ONLY BETWEEN 9:00 A.M. AND 9:00 P.M.):

Organization Information

5.  Name and address of organization receiving proceeds from solicitation:

Name: 

Address: 

City:  State:   Zip Code: 

6.  Purpose for which any receipts derived from the solicitation are to be used:

7.  Name and address of principal officer or manager of the applicant, if applicant is other than an individual:

Name: 

Address: 

City:  State:   Zip Code: 

8.  Name of the person by whom the receipts of the solicitation will be received and dispersed:

9.  Name and address of the person who will be in direct charge of conducting the solicitation:

Name: 

Address: 

City:  State:   Zip Code: 

10.  Outline the method to be used in conducting the solicitation:

11.  Provide a full statement of the character and extend of the charitable, education or philanthropic work being done in Roanoke County by the organization receiving proceeds from the solicitation:

12.  Federal tax employer identification number:  

13.  State tax-exempt identification numbers: 

14.  Federal tax-exempt identification numbers: 

Effective July 1, 2002, HB731 of the 2002 Virginia General Assembly updated the Virginia Freedom of Information Act. Email subscribers receiving information from a public body may, at their request, be exempt from having their email address given out should the email list be requested under the Freedom of Information Act (FOIA). If you would like to be exempted, please check yes below.
Exemption from Distribution:
Yes - I want my email address to be excluded from any FOIA distributions.
No - My email address may be included in any FOIA distributions.