Type Full Name :
Sign With Hand
I UNDERSTAND THAT, IF THE BOROUGH OF NEW PROVIDENCE ISSUES A CANVASSER'S PERMIT TO ME, THAT THIS PERMIT IS NOT TRANSFERABLE TO ANY OTHER PERSON AND THE FEE PAID IS NON-REFUNDABLE.
SSN # *
Organization Phone # *
Physical Characteristics
State *
Canvassing Permit Application
Applications will NOT be processed without proper documentation. Documents to be submitted with this application:
State License is Issued *
Background Information
Proposed Starting Date *
Date Of Birth *
First Name *
2. Notarized letter from company with proper signature(s), authorizing you to act as representative. If you are the company owner, a notarized letter stating this information.
Driver's License # *
If "Yes", please report date(s), location(s) of the offense(s) and detailed nature of the offense(s):
360 Elkwood Avenue, New Providence, NJ 07974
Tel: (908) 665-1400 ext.0/Fax: (908) 665-9272
www.newprov.org
Address *
Phone # *
(For Non-Profit or Charitable Organizations)
Applicant Signature
Have you ever been refused a canvassing permit in any town?
Supervisor's Name *
Have you ever been convicted of violating a municipal ordinance in any town?
State *
Outline the proposed disbursement of any funds to be collected, if applicable. Include overhead, administration, publicity, advertising and allocation of funds to the cause for which the canvassing is being made:
Organization Address *
City *
Sex
Proposed Ending Date *
Name of Organization *
Applicant Information
If yes, please give tax exempt #
Is the organization registered in New Jersey?
ZIP *
Have you been arrested or convicted of a crime or misdemeanor?
Last Name *
City *
1. Photocopy of Applicantƒ?Ts current driverƒ?Ts license. If there are additional canvassers for this application, please provide all canvasser's full name, addresses, and photo IDs.
Place of Birth *
lbs
Eye Color *
inch(es)
Borough of
New Providence
I DO SOLEMNLY DECLARE AND CERTIFY, UNDER THE PENALTIES OF THE LAW, THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT, AND THAT THE BUSINESS CONDUCTED WILL BE IN ACCORDANCE WITH THE ORDINANCES OF THE BOROUGH OF NEW PROVIDENCE.
If "Yes", please report date(s), location(s), of the offense(s) and detailed nature of the offense(s):
File Attachment
ZIP *
Weight
Organization Information
Is the organization tax exempt?
If "Yes", please report date(s), location(s) of the offense(s) and detailed nature of the offense(s):
Please provide all the vehicles related to this application.Click the 'Add new record' button for each vehicle. Enter all information and click 'Save'.
Outline the proposed method to canvass in this municipality:
Vehicles Details
Hair Color *
feet
Height
Email *