Randall W. Teague, Mayor
Director of the Department of
Public Works, Parks, and Public Property
John C. Foley, Commissioner Director of the Department of Revenue & Finance
Paul Dougherty, Commissioner Director of Public Safety
& Department of Public Affairs		Denise P. Adams Township Clerk / CFO
Jennifer DellaValle Tax Collector
Stuart A. Platt, Esq.      Municipal Solicitor
Tele: (856) 854-1176
Fax: (856) 858-8335
Web: www.haddontwp.com	
APPLICATION FOR CANVASSERS, COIN TOSSES, OR SOLICITATION

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

Applicant Information:

Name: ____________________________________________________________________________________
	First				Middle				Last

Current Address: ______________________________________________________
		     Street 					City/Municipality
		    ______________________________________________________
		     State					Zip

Has this been your primary residence for the previous three years? 	YES		NO 	(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	       HOME	WORK    (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: _____________________________________________________________________
			   Name						Phone
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?	YES		NO   	(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 Applicant							Date of Application

Please Note:

•	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.”
•	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.
•	A $10 permit fee applies upon receipt of this applicant.
•	Additional information able the rules and regulations for solicitation in Haddon Township is available through the Municipal Clerk’s Office or in the Code of the Township of Haddon Ch. 177.

__________________________________________________________________________________________

For Use by the Haddon Township Police Department:

Permit to be granted to applicant: 		YES			NO 		(circle one)

Date approved/disapproved: _____________________________________

Additional Comments: ______________________________________________________________________

________________________________________		___________________________________________
Signature of Chief of Police					Signature of Investigative Officer