Pacific Parking Inc. P.O.Box 3098-TCB West Orange, NJ 07052 Tel: 973 669 8777

Permit Application Email Fax: 973 669 8747

OFFICE USE ONLY

LOCATION

LYONS

/ Customer
NO / CARD
NO(15)

(PLEASE PRINT)

(2) Name______

Last First Mid Initial

(3) Address______E-MAIL______

(4) City______State______Zip Code______

(5) Home Phone______(6) Business Phone______

(Area Code) Telephone No. (Area Code) Telephone No

Employer______

Name Address

Automobile Information: Make Model Yr. Color Plate No.

(7) Car #1 ______

(8) Car #2 ______

PLEASE READ AND SIGN

PARKING LICENSE

1.  Customer shall have the license to park ONE of the cars listed above hereof in accordance with the terms on his parking privilege, at the prevailing rate. Payable on or before the first of each quarter, in advance, by mail to P. O. Box 3098-TCB West Orange, NJ 07052 or as designated by the terms of his parking agreement. This license shall be subject to the rules and regulations of the Parking Facility as stated from time to time by the Management thereof.

2.  The prevailing quarterly rate shall be effective only for the quarter for which it is paid and may be changed at any time for succeeding quarterly upon seven days notice.

3.  Customer shall lock his/her car at all times it is parked in the Facility and remove all valuables. Management shall not be liable for any damage to the car, or loss of contents.

4.  This Parking License is only a license to park effective only for the quarter for which payment has been made and accepted. It shall not be construed to be a lease or a bailment or confer any right to the use of the parking facility beyond the express terms of this license.

5.  Lost or damaged permit may be replaced for a fee.

6.  All payments are due, and must be post marked, by 20th of the month prior to the start of the next quarterly period.

7.  Parking Rate $45.00 Quarterly for non-resident

$39.75 for resident with proof of residency for Bernard’s Township. Make check payable to Pacific Parking Inc.

Note: If you are applying for a permit in the middle of a quarterly payment cycle, make payment for the months remaining in that cycle.

(Example: you are applying quarterly parking permit beginning May and the cycle stated in April your cost will be $26.50 or $30.00 non-resident to cover for the month of May and June.)

By______

Customer’s Signature Date