I am the (check appropriate) :

OwnerOccupant of the Premises

I understand that my address shall be placed upon a list to be kept by the Township Clerk. Addresses will remain on the registry until notification to the Township that the owner or occupant wishes to be removed. The list will be provided to any licensee who is issued a license to conduct door to door sales pursuant to the Township of Saddle Brook. Exempt by law are non-profit, charitable, religious or political groups.

Information to be included on “No Knock” Registry:

Street Number

Street Name

Saddle Brook, NJ 07663

Resident’s Name

Phone Number

Owner’s Name ( If different from resident )

Owner’s Phone Number

Owner’s Street

Owner City

State

Zip