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Get "circular Non-delivery Decal Order" Form - City Of Philadelphia

Please be advised that by signing this form you authorize The Department of Licenses and Inspections to issue violations to those who leave at your property any unsolicited handbill circulars including those which contain sale circulars and coupons. Mail or fax your completed and signed form to Attention Circular Free Property Coordinator 1401 John F. Kennedy Blvd. OFFICE USE ONLY City of Philadelphia Date Registered Department of Licenses and Inspections Circular Non-Delivery Decal Order Form As provided by section 10-723 of the Philadelphia Code the Department of Licenses and Inspections maintains a commercial handbill Non-Delivery list identifying all properties whose owners request nondelivery. If you do not want to receive hand delivered advertising circulars or handbills please fill out this form. To request non-delivery for local newspapers complete this form and provide a list of the local newspapers you do not want to receive. Please be advised that by signing this form you authorize The Department of Licenses and Inspections to issue violations to those who leave at your property any unsolicited handbill circulars including those which contain sale circulars and coupons. Property Owner Information or Authorized Lessee/Agent Full Name Mailing Address Street Phone Number City State ZIP FAX Number Property Requesting Non-Delivery Use legal address Property Address Street and unit if applicable I authorize I do not authorize the Department of Licenses and Inspections to use the above address or addresses on Code Violation Notices tickets when fining violators who leave unsolicited material at my property or properties. Mail or fax your completed and signed form to Attention Circular Free Property Coordinator 1401 John F. Kennedy Blvd. MSB 1180 Philadelphia PA 19102 FAX 215 686-2464 Provide the information below for each property requesting non-delivery. After this order form is processed you will receive a circular free property decal sticker which should be posted at your property visible from the sidewalk. I understand that the address I have listed above will appear on the Code Violation Notice sent to the party found in violation. I futher certify that the statements contained herein are true and correct to the best of my knowledge and belief. Choose one Signature Date. MSB 1180 Philadelphia PA 19102 FAX 215 686-2464 Provide the information below for each property requesting non-delivery. If you own more than one property use separate forms for each. Please print clearly. Please call 215 686-2414 for more information. Only the property owner or the property owner s authorized lesse/agent may request addition to the Non-Delivery listings.

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