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INSTRUCTIONS:
Pursuant to Ordinance 17-19, Section 3, §167-14.1 No Knock Registry of the Twp. of Washington BERGEN COUNTY. Please note, cable providers Optimum and Verizon are exempt, If you are/or were a customer within the past two years, they are considered to be performing customer service. Please complete all fields as indicated below and click the submit button. ONE REGISTRATION PER ADDRESS. DO NOT REGISTER THE SAME ADDRESS MULTIPLE TIMES - ONLY ONE PERSON FROM YOUR HOME NEEDS TO REGISTER

HOUSE NUMBER # (the number on your house)*

STREET NAME (Bergen County)*

EMAIL ADDRESS for registration confirmation*

DATE:*