Borough of Lindenwold
Police Department
Mercantile Registration Form
PLEASE TYPE OR PRINT LEGIABLY OR FORM WILL BE RETURNED
Mercantile Reg. #_____________
BUSINESS INFORMATION
Business name: ___________________________________________________________
Address: __________________________________________________________
___________________________________________________________
Business Phone #:_________________________________________________________
Business email contact:_____________________________________________________
Security Cameras Installed? (Please check one): YES__________ NO_____________
Security Alarm Installed? (Please check one): YES__________ NO_____________
If Yes: Alarm Company Name____________________________________
Alarm Company Phone #___________________________________
OWNER’S INFORMATION
Name:_______________________________________________________________________________
Address:_____________________________________________________________________________
_____________________________________________________________________________
Home Phone#:____________________________ Cell Phone #:_________________________
Emergency Contact #1
Name : _________________________________________________________________
Address: ________________________________________________________________
________________________________________________________________
Home Phone #: ______________________ Cell Phone #: ________________________
Emergency Contact #2
Name: __________________________________________________________________
Address: ________________________________________________________________
________________________________________________________________
Home Phone #: _______________________ Cell Phone #: _______________________
***PLEASE NOTIFY THE LINDENWOLD POLICE DEPARTMENT
IMMEDIATELY IF THERE ARE ANY CHANGES IN YOUR CONTACT
INFORMATION (856-784-7566)