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2. Business Occupancy Information
4. Business Name:*
5. Phone Number:*
6. Reason for Submission:*
   -- Select One --New Business OwnerUpdate Information
8. Premises Address:*
9. City: Cherry Hill
10. Zip Code:*
    -- Select One --080020803408003
12. Type of Business:*
13. Square Footage:*
17. Business Owner or Representative

    Person that is responsible for the occupied space; will receive notices of violations, etc.  

19. First & Last Name:*
20. Title:*
22. Mailing Address:*
24. City:*
25. State:*
26. Zip Code:*
28. Cell Number:*
29. Office Number:*
30. Email Address:*
32. Additional Contact:
33. First & Last Name:
35. Cell Number:
36. Office Number:
37. Email Address:
41. Emergency Contact(s)

    Local contact(s) that will respond to the premises in the event of an emergency.

43. First & Last Name:*
44. Cell Number:*
45. Email Address:*
47. First & Last Name
48. Cell Number:
49. Email Address:
53. Accounts Payable

    Department or person responsible for receiving and processing the Annual Fire Safety Use Registration Fee Invoice. This fee is issued  annually to all businesses located in our jurisdiction.

55. Business Name:*
56. Attention:*

    Such as - accounts payable, licensing, maintenance, etc.

58. Mailing Address (If different from premises):
59. City:
61. State:
62. Zip Code:
63. Invoice Delivery: *
    -- Select One --Please email the invoice.Please mail a hard copy.

    Please select your preferred mode of invoice delivery.

65. Accounts Payable Email Address:*
67. Contact Person:
68. Position:
    -- Select One --Accounts PayableBusiness OwnerLicensing
70. Phone Number:*
71. Phone Extension:
72. Email Address:
74. Additional Information:

    Please use this space to provide any additional information pertaining to your business or contacts. Email questions to fmadmin@chfd.org.

Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit Submit and Print

* indicates a required field