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PLC:

a006vo

Agency:

village of westville

For:

solicitor license

Phone:

217-267-2507

Address:

201 n state street
westville, illinois 61883

*Required Field

Payment Information

*Name or Company Name:

*Address:

*City:

*State:

*Zip:

License Fees equals

$100.00 per month

$1000.00 per year

Example: Company ABC would like to be a solicitor for 1 month and has 5 employees they would like to solicit.

The fee would be $100 for the company plus $250 for the employes totaling $350

MONTHLY License Fee - select either monthly or yearly:

YEARLY License Fee - select either yearly or monthly:

Notes:

Payment Amount

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number: