Warren Cable TV 34 Form

FOR WTCTVC USE ONLY
REQUEST NO.

COMMUNITY ANNOUNCEMENT REQUEST FORM
WARREN TOWNSHIP CABLE TV - CHANNEL 34

ORGANIZATION:

ADDRESS:

PHONE NO.

NAME OF
ORIGINATOR:

DATE:

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(PRINT)(SIGNATURE)
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ANNOUNCEMENT: (Please print. Limited to six lines, 28 characters and spaces per line.)

DATE(S) REQUESTED TO DISPLAY: FROM: ___________________________ TO: ____________________________
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COMPLETED FORM MAY BE DROPPED OFF AT THE TOWN CLERK, WARREN MUNICIPAL BUILDING, OR MAILED TO:

WARREN TOWNSHIP CABLE TV COMMITTEE
46 MOUNTAIN BOULEVARD
WARREN, NJ 07059

ALL REQUESTS MUST BE RECEIVED TEN DAYS PRIOR TO INITIAL DISPLAY. ACCEPTANCE IS SOLEY AT THE DISCRETION OF THE WARREN CABLE TV COMMITTEE. NOTIFY WARREN TOWNSHIP CABLE TV COMMITTEE IMMEDIATELY OF ANY CHANGES OR DELETIONS.
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FOR WTCTVC USE ONLY:
ACCEPTED: _____________________________

NOT ACCEPTED: __________________________

REASON: ________________________________