Transient Merchant Registration - Wisconsin (Page 2 of 2) in pdf

9. Has applicant ever been convicted of any crime or ordinance violation related to applicant’s transient merchant

business within the last five years?

____ No

____Yes – Nature of offense & place of conviction ______________________________________

Section 2: Individual or Partnerships Only (list each partner)

Applicant Name _____________________________________________________________________________

(Last, First, Middle Initial)

Birthdate _________________

Height ________ Weight ________

Hair ________

Eyes ________

Applicant Name _____________________________________________________________________________

(Last, First, Middle Initial)

Birthdate _________________

Height ________ Weight ________

Hair ________

Eyes ________

Applicant Name _____________________________________________________________________________

(Last, First, Middle Initial)

Birthdate _________________

Height ________ Weight ________

Hair ________

Eyes ________

I, ______________________(applicant), hereby appoint the City Clerk of Madison as agent to accept services of

process in any civil action brought against me arising out of any sale of services performed by me in connection

with my transient sales activities in the event I cannot, after reasonable effort, be served personally, which action

shall be brought in Dane County, Wisconsin, all of which is pursuant to the requirements of the Madison General

Ordinances, Section 9.17(4)(d).

SUBSCRIBED AND SWORN TO BEFORE ME:

this __________ day of _____________, 20_____

__________________________________________

Signature of Applicant

________________________________________

Notary Public

My commission expires_____________________

Section 3: Corporations or Limited Liability Companies Only

A Corporation of Limited Liability Company (LLC) which has named a current registered agent for service and

process in Wisconsin through the Wisconsin Secretary of State’s Office and which establishes that it is in good

standing with such Office, may register in its Corporate/LLC name by an authorized agent if the Corporation/LLC

uses only its own employees to transact a business for which the registration is sought.

I hereby appoint ____________________________ as agent to accept services of process in any civil action

arising out of any sale of services performed by _______________________________ (name of Corporation or

LLC), in connection with its transient sales activities and that the Corporation/LLC is in good standing with the

Wisconsin Secretary of State, pursuant to the requirements of the Madison General Ordinances, section

9.17(4)(d).

SUBSCRIBED AND SWORN TO BEFORE ME:

this __________ day of _____________, 20_____

__________________________________________

Signature of Authorized Agent, Corporate Officer or LLC Member

(proof of authorization required)

________________________________________

Notary Public

My commission expires_____________________

Transient Merchant Registration - Wisconsin Page 2

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