NEW JERSEY STATE ASSOCIATION OF CHIEFS OF POLICE CAR SHIELD APPLICATION (SHIELDS ARE FOR ACTIVE &


RETIRED STATUS MEMBERS ONLY) CAR SHIELDS ARE THE PROPERTY OF NJSACOP AND ARE SUBJECT TO FORFEITURE FOR ABUSE OR MISUSE.


NAME: ____________________________________________


ADDRESS: _________________________________________ _________________________________________________ VEHICLE MAKE: ____________________________________ YEAR: __________ REGISTRATION#: ___________________


DEPARTMENT: ______________________________________


NJSACOP Office Use Only Received: ______________ Approved: Yes ___ No ___ Shield # _______________ Committee Chairperson: ________________________________


PLEASE CHECK ONE: CHECK ___ VOUCHER ___ CREDIT CARD: MC ___ VISA ___ AMEX ___ CREDIT CARD #: ________________________________________ EXP. DATE: __________________ CC BILLING ADDRESS: ______________________ ________________________________________ SIGNATURE: ________________________________________


CAR SHIELDS CAN BE PICKED UP AT NJSACOP MONTHLY BUSINESS MEETINGS OR ADD $4 TO


ABOVE FEE FOR MAILING COSTS. MAILING ADDRESS: NJSACOP


ONE GREENTREE CENTRE, SUITE 201 MARLTON, NJ 08053


FAX: 856.810.0223


COPY OF VEHICLE REGISTRATION MUST ACCOM- PANY THIS APPLICATION ALONG WITH FEE OF $25.


NEW JERSEY STATE ASSOCIATION OF CHIEFS OF POLICE BADGE APPLICATION


TITLE: ______________________________ NAME: ___________________________________________ DEPARTMENT: _____________________________________ ADDRESS: _________________________________________ _________________________________________________ PHONE: _______________________________


COST: $40.00 PLEASE CHECK ONE STATUS: ___ ACTIVE


___ RETIRED ___ RETIRED LIFE


OR ___ ASSOCIATE ___ CORPORATE ___ PRIVATE SECURITY


PLEASE CHECK ONE: CHECK ___ VOUCHER ___ CREDIT CARD: MC ___ VISA ___ AMEX ___ CREDIT CARD#: ________________________________________ EXP. DATE: _________________


CC BILLING ADDRESS: _____________________ ________________________________________


SIGNATURE: ________________________________________


MAILING ADDRESS: NJSACOP


ONE GREENTREE CENTRE, SUITE 201 MARLTON, NJ 08053


FAX: 856.810.0223


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