Canvass permit

North Caldwell Police Department

Chief Karl W. Strodthoff
Email
Borough of North Caldwell Police Department
136 Gould Avenue, North Caldwell, New Jersey 07006
Telephone (973) 226-0800 Fax (973)-228-6427
http://www.northcaldwell.org
CANVASSING PERMIT APPLICATION BOROUGH OF NORTH CALDWELL
All applications must be submitted along with a 2" X 2" photo of said applicant. After background check and fingerprint results have been received, a $50 fee is required by each individual applicant. Please make all checks payable to "The Borough of North Caldwell".

Please use one of the tools below to take or upload a photo.
Take Photo
File Upload

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NAME OF APPLICANT*
PHONE #*
Format: (000) 000-0000.
PERMANENT ADDRESS*
LAST ADDRESS if less than 5 yrs*
Social Security Number *
DATE OF BIRTH*

MonthDayYear
Date
PLACE OF BIRTH*
YESNO
IF NO, WHERE
SEX:*
RACE:*
WEIGHT:*
HEIGHT:*
EYE COLOR:*
HAIR COLOR:*
DRIVERS LICENSE*
YESNO
IF YES, ADD POLICE REPORT & EXPLAIN:*
VEHICLE TO BE USED IN BUSINESS REGISTRATION
STATE:
YEAR
MAKE
MODEL
COLOR
ATTACH A PHOTO COPY OF THE INSURANCE CARD TO THIS APPLICATION

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OWNERS NAME ADDRESS*
EMPLOYERS NAME*
PHONE*
Format: (000) 000-0000.
EMPLOYERS BUSINESS ADDRESS*
BRIEF DESCRIPTION OF SERVICES AND/OR GOODS TO BE SOLD:*
TIME PERIOD IN WHICH SOLICITING OR CANVASSING IS TO BE CONDUCTED?
START DATE*

MonthDayYear
Date
END DATE*

MonthDayYear
Date
WORKING HOURS*
OTHER TOWNS WHERE A CANVASSING PERMIT WAS ISSUED IN THE LAST YEAR:
TOWN, STATE (SEPERATE BY COMMA) USE "N/A" IF NONE*
All applicants must be fingerprinted. Please go to the following website to schedule an appointment: http://uenroll.identogo.com/ The Service Code to enter is 2F17ZY. Our Agency's ORI is NJ0071500.

All applicants will be issued a current list of do not solicit from the Borough Clerk. I understand that if I violate that, if I solicit/canvass, the address on the list will be cause for immediate revocation of the permit.

I AUTHORIZE THE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. | UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS CALLED FOR IS CAUSE FOR IMMEDIATE REVOCATION OF PERMIT. I HEREBY CERTIFY THAT THE INFORMATION ON THIS APPLICATION IS THE TRUTH TO THE BEST OF MY KNOWLEDGE

APPLICANTS SIGNATURE
Signature* Date* Email*
Should be Empty:

North Caldwell Police Department

Borough of North Caldwell Police Department136 Gould Avenue, North Caldwell, New Jersey 07006Telephone (973) 226-0800 Fax (973)-228-6427http://www.northcaldwell.org

CANVASSING PERMIT APPLICATION BOROUGH OF NORTH CALDWELL

TIME PERIOD IN WHICH SOLICITING OR CANVASSING IS TO BE CONDUCTED?

OTHER TOWNS WHERE A CANVASSING PERMIT WAS ISSUED IN THE LAST YEAR:

Borough of North Caldwell Police Department
136 Gould Avenue, North Caldwell, New Jersey 07006
Telephone (973) 226-0800 Fax (973)-228-6427
http://www.northcaldwell.org