Request Form

REQUEST FORM

I, ________________________,

owner of property at ______________________________,  

Ridgefield Park, New Jersey, wish to participate in the Sidewalk Repair Program.    

My phone number is ___________________.    

Please inspect my property and provide authorization/reimbursement forms and instructions.    

Address of property owner if different from above:    

________________________________________    
 

________________________Signature of Homeowner  

DATED:_____________