Convenience Center Sticker Registration Form

Convenience Center Sticker Registration Form
Property Owner's Name:

First NameLast Name
Tenant's Name (If Applicable):

First NameLast Name
Property Address
City
State
Zip Code
Block
Lot
Own or Rent
Home Phone
Work Phone
Cell Phone
E-mail
Vehicle Make
Vehicle Model
Vehicle Year
Vehicle Color
Vehicle License Plate #
I understand that I can only dispose of items which are within my residence listed above. I also understand that if any of the above information is falsified or I violate the rules and regulations governing the use of the convenience center then the sticker to use the convenience center may be revoked and deemed invalid.
Enter the message as it's shown*
Date of Issuance
Approved By
Sticker Number
Should be Empty: