Hotel Motel Extended Guest Registration Form

The below is for Non-Emergency Use Only. To report an Emergency please call 911.

Staff will respond to Communications during normal business hours, Monday through Friday, 8:30 am to 4:30 pm, except holidays. Your patience is appreciated.

Business Administrator

Christopher J. Tietjen
Town Hall
475 Valley Road
Wayne, NJ 07470

973-694-1800 X 3202

Or, submit online form below:

Name of the Facility:

Address of Facility:

Facility Contact Information:

Name:

Phone #:

Email:

Fax #:

Guest Information:

The full name of Guest:

Address of Guest:

Unit number occupied:

Number of days staying:

Date of check-in:

Time of check-in

Reason for stay beyond 30-day period:

Date:

FOR OFFICIAL USE ONLY

Date Received:

Decision:

Decision Date:

Your session has timed out.

Click here to access the application.

Hotel Motel Extended Guest Registration Form

Facility Contact Information:

Guest Information:

FOR OFFICIAL USE ONLY