***Please fill out this application by typing your information in the blue areas, print and then either fax or mail completed application to our office.*** SYRACUSE UNIVERSITY 2015-2016 LIMITED RESIDENCY PARKING APPLICATION Please have S.U.I.D card number when applying. Incomplete applications will not be processed. Please print all information clearly and include your signature(s). All citation balances must be paid before permits will be issued. Personal Information: Name: (last, first, middle) SUID #: ___________________________________ _________________________________________________ Permanent Phone #: ________________________ Permanent Address: ______________________________ Cell Phone #: ______________________________ _________________________________________________ Work Phone #: ____________________________ Residency program: ______________________________ Email Address: ____________________________ Permit Information: Please check the appropriate box and sign as indicated below. 1 Week equals seven (7) consecutive days – parking for more than 7 days, please select a two week permit and so forth. Beginning date of residency ___________________________________ End date of residency ___________________________________ I wish to purchase a permit for South Campus. 3 Wks = $55.50 2 Wks = $37.00 1 Wk = $18.50 4 Wks = $74.00 5 Wks = $92.50 4 Wks = $74.00 5 Wks = $92.50 4 Wks = $168.00 5 Wks = $210.00 I wish to purchase a permit for Manley. 1 Wk = $18.50 3 Wks = $55.50 2 Wks = $37.00 I wish to purchase a permit for West Campus. Vehicle Information: STATE 3 Wks = $126.00 2 Wks = $84.00 1 Wk = $42.00 Please send a copy of vehicle registration along with this form. PLATE Payment Information: MAKE MODEL COLOR YEAR PLEASE CHECK APPROPRIATE BOX (ES) & SIGN AS INDICATED BELOW PAYMENT OPTIONS: Check (made payable to Syracuse University) Credit card (Master Card or Visa) ____ EXPIRATION DATE: Signature (for CC charges) ________________________________________ Date:_______________________________ I UNDERSTAND THAT PARKING IS AT MY OWN RISK AND THAT I AM RESPONSIBLE FOR ALL SYRACUSE UNIVERSITY PARKING RULES AND REGULATIONS. X SIGNATURE ______________________________________________________ FOR OFFICE USE ONLY: PERMIT TYPE COMMENTS : PERMIT TYPE COMMENTS : PERMIT NUMBER HOME LOT ISSUE DATE END DATE FEE AUTHORIZED BY: PERMIT NUMBER HOME LOT ISSUE DATE END DATE AUTHORIZED BY: Submit PAYMENT TYPE ISSUED BY: FEE PAYMENT TYPE ISSUED BY:
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