DEPARTMENT SERVICE PERMIT
 REQUEST FORM
ARKANSAS STATE UNIVERSITY
Department of Parking Services
870-972-2945


  NOTE:  Department placards must be requested by deans and vice-chancellors.  
  There is an $85.00 fine for misuse of department placards.  Parking Services will
  reserve the right to invalidate department permits that are misused. 

  PRICING:  Department placards are $70.00 each.  Please issue IDT to ASU Parking
  Services.  Completed IDT must be presented to Parking Services before placard
  will be issued.
 

  Dean/Vice-Chancellor Contact Information
  NAME OF DEAN/VICE-CHANCELLOR

  ASU ID NUMBER

  EMAIL ADDRESS

  COLLEGE, DIVISION, OR DEPARTMENT
  THAT WILL BE USING THE PERMIT

  BUSINESS MAILING ADDRESS

  CITY, STATE, ZIP

  BUSINESS PHONE

  NUMBER OF PERMITS REQUESTED

  Permit Information


In the comment box below, please provide the name and ID number of each employee that will be authorized to use the department placard.  Please also indicate the general purpose for use of the placard. 

Thank you.

  Delivery Options (please check one):

We will pick up permit at Parking Services during regular business hours.

Please deliver the permit to the following location:

Building       Room Number
 

I affirm that I have read the section of the 2006-07 Parking/Motor Vehicle Regulations
     regarding the use of department permits.

 A confirmation email will be submitted to the dean/vice-chancellor listed above which will include an attached invoice and payment instructions.

BE SURE TO PRINT A COPY FOR YOUR RECORDS!


David R. McKinney, Director of Transit/Parking Services
Copyright © 2007 [Arkansas State University]. All rights reserved.
Revised: December 06, 2007 .