Agent to Act Request Form

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Please correct the field(s) marked in red below:

As a property or business owner within the Town of Morrisville, you are able to authorize the Morrisville Police Department and it's officers to act as your agent in ordering individuals to leave your premises in your absence. If you are interested in participating in, or receiving information about, this program, fill out and submit the required information and an officer will contact you within 10 business days.
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Contact Person Name:
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Telephone Number:
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Email Address:
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Select the Type of Location to Enroll in the Program:
Select the Type of Location to Enroll in the Program:
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Name of Business:
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Address of Specific Location:

Completing this form prior to the officer contacting you may speed up the registration process.