Parking & Transportation Services 340 Bonair Siding, Stanford, CA 94305-7255 T. 650.723.9362 F. 650.724.8676 transportation.stanford.edu $100, $75, $50, or $25 2014-15 Permit-Return Application I want to participate in the2014-15 Permit-Return Promotion! I plan to use the following commute mode(s) for the duration of my commitment (indicate primary mode with “1” and use “X” for any additional modes): ______Train ______Bike ______Walk ______Bus ______Vanpool ______Carpool ______Other ______________________________ My permit-return commitment is indicated below: Check One Deadline to return your permit (before 5 p.m.) Incentive Duration of commitment amount $100 5 months (Nov. through March) Oct. 31 $100 5 months (Dec. through April) Nov. 26 $75 4 months (Nov. through Feb.) Oct. 31 $75 4 months (Dec. through March) Nov. 26 $50 3 months (Nov. through Jan.) Oct. 31 $50 3 months (Dec. through Feb. Nov. 26 $25 2 months (Nov. and Dec.) Oct. 31 $25 2 months (Dec. and Jan.) Nov. 26 Type of “A,” “C,” “Z,” or motorcycle permits accepted Annual and Academic Year permits only Program restrictions: Must return your Stanford annual (expiring in August 2015) or academic year (expiring in June 2015) permit. Short-term, residential, carpool, and vanpool permits are not eligible for this promotion. Eligible long-term permits must have been purchased on or before Oct. 29, 2014, to be eligible for this promotion. Contact us at [email protected] about eligibility if you are new to Stanford and recently purchased a long-term permit. Must join the Commute Club* (Clean Air Cash or Carpool Credit) by published deadline to participate. Must not purchase or utilize a parking permit (other than daily scratchers, carpool permit, or vanpool permit) during the commitment period. Exchanging an “A” or “C” for a “Z” permit does not qualify for this promotion. Must be an eligible commuter, required to be on campus at least 20 hours a week during normal weekday business hours, through the commitment period. Participants in previous permit-return or permit non-renewal promotions who received a reward within the last four years are ineligible. Individuals who have been enrolled in the Commute Club within three months prior to returning their permit are ineligible for this promotion. The permit-return bonus is paid only after you complete all or an eligible part of the commitment period. If you repurchase a permit (other than daily, carpool, or vanpool permits) before your commitment ends, you may forfeit all or a portion of your Clean Air Cash, Carpool Credit, and Permit-Return Promotion reward. *Commute Club eligibility. You are eligible for the Commute Club if you meet all of the criteria on the Commute Club application and the P&TS website: http://commuteclub.stanford.edu. Final eligibility is determined at the discretion of P&TS. Please send an email to [email protected] for assistance. Page 1 of 2 I agree to the above program restrictions. I understand that if I intentionally give false information to obtain membership in the Commute Club or to participate in this promotion, I may lose my privilege to receive any transportation benefits from Stanford University, and I may receive disciplinary action up to and including termination of employment or expulsion. Printed name: ________________________________________________ Stanford/Hospital ID:______________________ Email and/or phone: ______________________________________________________________________________________ Signature: ____________________________________________________ Date: __________________________________ Submit this form when you return your permit at P&TS, 340 Bonair Siding, Monday through Friday, 7:30 a.m. to 5 p.m., except holidays. You may also submit it via fax (650.724.8676) or email ([email protected]). Don’t forget to enroll in the Commute Club, too! Page 2 of 2
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