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4. Pursuant to Ordinance No. 388, the Township of Richland has established a "Do Not Solicit Registry" (sometimes referred to herein as "the registry"). The purpose of the Registry is to protect the health, safety, welfare, and privacy of residents by allowing residents to register their residence address on the Township's "Do Not Solicit Registry". 

   In accordance with the terms and conditions of the above referenced Ordinance, I request that my address be included on the "Do Not Solicit Registry". 

   I understand that the information submitted as part of this application, including my name, is subject to public inspection pursuant to the Pennsylvania Public Records Act. I further understand that the "Do Not Solicit Registry" containing only addresses will be given to each transit retail merchant who "possesses a valid solicitation permit and that any person may acquire a current copy of the "Do Not Solicit Registry" subject to payment of duplication costs. Moreover, I understand that the registry should not replace common and reasonable measures to prevent unwanted solicitation, such as posting "No Solicitation" signs. In addition, I understand that it is my responsibility to remove my name and residence address from the Registry when I move and/or when I so desire. 

8. Name*
9. Email Address*
11. Address*
13. City*
14. State*
15. Zip Code*
17. Phone Number*
18. Email Address*
22. Signature*

    By the following selection and confirmation, I hereby sign this form.

    1. Yes
    2. No
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24. 1. Receive an email copy of this form.
25. Email address

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26. Submit

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