***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: