Annual Parking Permit Enrollment Form

2. Annual Parking Permit Information Explanation of Benefits and Requirements

4. Explanation of Benefits and Requirements
   Benefits and Requirements

   Please open and read prior to completing the Annual Parking Permit Enrollment Form

8. Enrollment Form

10. Date:*
    Date:

12. Name*

14. Mailing Address*

    Street Address or PO Box

16. City*

17. State*

18. Zip*

20. Email Address

22. Phone Number

23. Cell Phone Number

27. Applicant Information
    -- Select One --Fayetteville ResidentOut-of-Town ResidentEmployee of Entertainment DistrictU of A StudentOther

    (Optional - Select all that apply)

31. Vehicle Information*:
    * A copy of the current vehicle registration of vehicle that permit is being issued to is Required.<br> * Annual Parking Permit issued is for this vehicle ONLY and is not transferable to another vehicle or another individual.

    * A copy of the current vehicle registration of vehicle that permit is being issued to is Required.
    * Annual Parking Permit issued is for this vehicle ONLY and is not transferable to another vehicle or another individual.

33. License Plate No.*

34. State*

35. Make*

37. Model*

38. Year*

39. Color*

41. Vehicle Registration*

45. Mail Permit To:

    1. Mailing Address (above)

    1. Pick up at Parking Office

49. I hereby agree to the following:
    My City of Fayetteville parking permit is for my individual use and may NOT be sold or transferred to another individual. Any vehicle with unpaid parking citations on permitted vehicle is subject to suspension of parking permit until all citations are paid. Payment of parking citations may be made by cash, check, or credit card. (See Penalty for Misuse)

    My City of Fayetteville parking permit is for my individual use and may NOT be sold or transferred to another individual. Any vehicle with unpaid parking citations on permitted vehicle is subject to suspension of parking permit until all citations are paid. Payment of parking citations may be made by cash, check, or credit card. (See Penalty for Misuse)

51. Electronic Signature Agreement

    1. I agree.

    By checking the "I agree" box above, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

53. Electronic Signature

54. Date
    Date

58. OFFICE USE ONLY

60. Permit Number:

61. Permit Year:

62. Issue Date:

64. Prorated Days (if any)

65. Amount Paid:

66. Date Picked Up/Mailed:

Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field