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2. Contact Information of Donation Bin Company
4. Company Name*
5. Name of Contact *
7. Email Address*
8. Phone Number*
10. Physical Address*
11. Fax Number*
15. Property Owner Information
17. Block*
18. Lot*
20. Location of Bin - Address*
21. Name of Property Owner*
23. Consent of Property Owner*

    1. Yes, I attest

    By checking this box I attestthat I have received written consent from the property owner to place a donation bin s)

24. Written consent of property owner

    Please attach the written consent of the property owner here

28. Office of the Company Sharing Profit
30. Company Name*
31. Email Address*
33. Contact Name*
34. Phone Number*
36. Address*
38. Description of how clothing and donation's collected will be used. sold or dispersed:*
40. Description of how the proceeds of donations will be allocated:*
42. Chapter 96: Donation Bins
    Chapter 96: Donation Bins
43. Review of Chapter 96*

    1. Yes, I consent

    By checking this box, I consent that I have reviewed and understand Township Code, Chapter 96 pertaining to Donation Bins

45. Scaled Survey / Plot Plan*

    Copy of an accurately scaled survey/plot plan that shows all existing and proposed construction drawn to scale and setback dimensions from property lines of all proposed donation bins

49. Township owned property

    Certificate of Liability Insurance, noting Wall Township as additionally insured, in the amount of 1 (one) million dollars if the bins are located on Township-owned property.

51. Fee

    The annual permit fee is $50.00 (fifty dollars) per bin.  Checks can be made payable to the Township of Wall.  We also accept credit and debit cards; please contact (732)449-8444 ext. 2200 to provice payment details. 

52. Number of Bins*

    Please indicate how many bins will be on the property

Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit Submit and Print

* indicates a required field