Convenience Center Sticker Registration

Property Owner's First Name:

Property Owner's Last Name:

Property Address *

City

State *

Zip

Block *

Lot *

Own or Rent *

Own

Rent

Home Phone *

Work Phone *

Cell Phone

E-mail *

Vehicle Make *

Vehicle Model *

Vehicle Year *

Vehicle Color *

Vehicle License Plate # *

Please send a copy or photo of NJ Vehicle Registration

Choose File

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.

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Below for Office Use Only:

Date of Issuance

Approved By

Sticker Number

Address

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