2384-13 License Application - Final.pdf

TOWNSHIP OF WEST ORANGE 60 MAIN STREET WEST ORANGE, NJ 07030 (973) 325-4155 (973) 731-1196 FAX LICENSE APPLICATION TO OPERATE “SHOP LOCAL” REWARD PROGRAMS Name of Applicant: Contact Person: Job Title: Address: City: State: Zip: Business Phone: Cell Phone: Email Address: Customer Service Phone: Customer Service Email: The above-named entity and/or individual agrees to adhere to the provisions of Chapter 5, Section 33 of the Municipal Code of the Township of West Orange, and to the terms and conditions specified in the foregoing pages of this license application. Signature of Applicant: ________________________________________________ Print Name and Title: Date: ________________