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2. Applicant First Name
3. Applicant Last Name
5. District Address
7. City
8. State
9. Zip
13. Mailing Address
15. City
16. State
17. Zip
19. Email Address
21. Home Phone
22. Cell Phone
26. Zone

    1. North Zone (North of Dickson Street)
    2. South Zone (South of Dickson Street)
27. Resident Info

    1. Homeowner living in district
    2. Homeowner living outside of district
    3. Renter
29. Guest Passes (Optional)

    1. 2 hang tags (unlimited use)
33. Proof of Residency - Homeowners must renew annually; renters of properties within the district must renew semi-annually.

    (Must provide one of the following)

    1. Current vehicle registration
    2. Property tax bill
    3. Residential lease agreement
35. Upload copy of proof of residency
39. Vehicle Information
    Must provide current vehicle registration of vehicle that the permit is being issued to.
    Resident Parking Permit issues is for this vehicle only and is not transferable to another vehicle or individual.
41. License Plate Number
42. State
44. Make
45. Model
47. Year
48. Color
50. Mail Permit To

    1. Address in District
    2. Mailing Address
    3. Pick up at Parking Office
54. I hereby agree to the following: my city of Fayetteville parking permit is for my individual use and may not be transferred to anther 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.
    
    All resident permits, hang tags and guest passes can only be used for residents and their visitors, may not be sold or transferred, and have no monetary value.
56. Electronic Signature Agreement

    By checking the "I agree" box below, 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.

    1. I agree.
58. Electronic Signature
62. Forms and documentation may also be printed and returned directly to the Parking Management Office at 113 West Mountain Street or faxed to 479-575-8250.
Leave This Blank:


64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit

* indicates a required field