MunicipalBuilding
135 Haddon Avenue
Haddon Township, NJ08108 / / Tele: (856) 854-1176
Fax: (856) 858-8335
Web:

APPLICATION FOR CANVASSERS, COIN TOSSES, OR SOLICITATION

Please complete this entire application to be reviewed by the Chief of Police.

Applicant Information:

Name: ______

FirstMiddleLast

Current Address: ______

Street City/Municipality

______

StateZip

Has this been your primary residence for the previous three years? YESNO (circle one)

If no, please list previous residences in this time period: ______

______

Date of Birth: ______Social Security #: ______

Driver’s License #: ______State: ______

Applicants must supply a copy of their VALID driver’s license or other GOVERNMENT ISSUED ID with photo.

Phone Number: (______) ______CELL HOMEWORK (circle one)

Please supply another number (if possible) where you can be reached: ______

Employer Information: If applicant is representing a specific firm or employer, please complete the following section and submit a letter or other written statement from the authorizing agent at said firm/employer certifying that the above applicant is authorized to represent said firm/employer.

Company Name/Address: ______

______

______

Immediate Supervisor: ______

NamePhone

Please describe the merchandise to be sold, offered for sale, the nature of the service being offered, or information on the group/organization benefiting from solicitation: ______

______

______

FORM CONTINUES ON NEXT PAGE

Criminal Background Information:

Have you ever been convicted of a crime or disorderly person’s offense?YESNO (circle one)

If yes, when? ______

Where? ______

Describe offense: ______

______

______

Signature of Applicant:

By signing below, the applicant swears that the information supplied above is correct. This application will be submitted to the Chief of Police for an investigation of the “applicant’s business and moral character as…deemed necessary for the protection of the public good.”

______

Signature of ApplicantDate of Application

Please Note: (Refer to Ordinance #1293)

  • The Chief of Police and the Township of Haddon reserve the right to deny right for solicitation “…if, as a result of the investigation, the applicant’s character or business responsibility is found to be unsatisfactory.”
  • Permit Fee/Application Fee is $575.00
  • If a solicitation permit is awarded, the permit is only valid Monday – Friday 10:00 am to 5:00 pm. Solicitation outside of this time period is subject to the penalties stated in the Code of the Township of Haddon Ch. 177.The permit expires December 31 of the year the permit is issued.
  • Additional information able the rules and regulations for solicitation in HaddonTownship is available through the Municipal Clerk’s Office or in the Code of the Township of Haddon Ch. 177.
  • CHARITABLE ROADWAY SOLICITATION IS PROHIBITED IN INCLEMENT WEATHER
  • ORGANIZATIONSARE RESPONSIBLE TO OBTAIN AND WEAR ANSI 107-2004 #2 OR #3 NJDOT APPROVED VESTS.

______

For Use by the Haddon Township Police Department:

Permit to be granted to applicant: YESNO (circle one)

Date approved/disapproved: ______

Additional Comments: ______

______

Signature of Chief of PoliceSignature of Investigative Officer

MunicipalBuilding, 135 Haddon Avenue, Haddon Township, New Jersey08108