Fireworks - Vendor Permit Application

Business Name *

Contact Name *

First

Last

Mailing Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Email Address *

Phone Number *

Sale Location *

Sale Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Sales Premise *

Retail Store
Vending Structure: Trailer/Tent/Vehicle
Other

Provide Details for Other Sales Premise *

Dates fireworks to be offered for sale *

Victoria Day
Canada Day
Diwali
Chinese New Year

Includes 8 days prior to the date.

Insurance Upload *

Click or drag a file to this area to upload.

Please upload a copy of your Commercial General Liability Insurance.

The permit is for the sale of fireworks on the location and date as specified only, and to the party to whom it is issued, and is not transferrable.

I acknowledge having read the Fireworks By-law No. 039/14 and have completed the application accurately and truthfully. By signing this application I agree to adhere to the requirements of the By-law and to the terms and conditions of the permit. *

I acknowledge having read the Fireworks By-law No. 039/14 and have completed the application accurately and truthfully. By signing this application I agree to adhere to the requirements of the By-law and to the terms and conditions of the permit.

Signature *

Clear Signature

Authorization by Owner

The application is signed by an individual other than the owner of the property:

Yes
No

File Upload

Click or drag a file to this area to upload.

The Vendor Permit-Sale of Fireworks Owner Authorization Form must be submitted with your application

Sale of Fireworks Permit

Price: $116.00

Convenience Fee +1.75%

Price: $2.03

Stripe Credit Card *

Card

Name on Card

Personal information on this form is collected under the authority of the Municipal Act and the Fire Protection and Prevention Act and will be used to determine the eligibility of a permit. The information is used for the purpose of processing this application and administering the legislation and is maintained in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Questions regarding the collection of this information may be directed to the Township Clerk’s office.

The Township of Puslinch is committed to providing accessible formats and communication supports for people with a disability. If another format would work better for you, please contact the Township Clerk’s office for assistance.

Fireworks – Vendor Permit Application

Authorization by Owner

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