Please provide the following information for participation in the Residential Decal Program. Return this completed form with your annual fee of $20.00. If you wish to purchase the Residential visitor permit at this time, include an additional $20.00.

Date

Name (Print) Last First

Street Address Apt. #

City State Zip Code

Business Phone Home Phone

Registered Vehicle: (If your license plate no. has the number zero, enter as Ø.)

Make Model Year Veh. Lic. #

Color State of Registration Body Type

RULES, REGULATIONS AND CONDITIONS

1. Attach to this registration proof of ownership of the home address or provide a copy of the lease agreement.
2. A new registration form must be submitted annually to continue participation in the program, expiration date on decal serves as notice.
3. If the vehicle is sold or title is transferred, the decal will be replaced at no charge when returned; if not returned, written notice is required along with a replacement fee of $5.00.
4. Documented misuse or abuse of the decal will result in a suspension of privileges for a period not to exceed one (1) year. Examples (Please acknowledge by initialing):

_______(1) Transferring decal from one vehicle to another.

_______(2) Excessive parking citations.

1. Vehicle is subject to citations and towing for overtime parking in commercial loading zones if parked for more than 20 minutes.
2. Visitor permit is subject to #'s 4 and 5 above.
3. A refund is allowed only in the event of an initial rejection of this registration.
4. Only one (1) decal and one (1) visitor permit is allowed per address.
5. If a decal or visitor permit is lost, stolen or misplaced, only one (1) replacement will be issued within one (1) year period. Replacement fee is $5.00.
6. Decal is non-transferable. It is the decal holders responsibility to contact the Parking Division of any changes in vehicle status. Note: Unauthorized transfer of decal may result in impoundment of vehicle.

I hereby consent and agree to abide by these rules, regulations and conditions and confirm that I have fully read and understand the above.

Signature

Please check appropriate purchases which apply:

RESIDENTIAL DECAL $20.00_____ RESIDENTIAL VISITOR PERMIT $20.00_____

WILL PICK UP ___________ CERTIFIED MAIL DELIVERY $5.10

TOTAL AMOUNT OF CHECK OR MONEY ORDER SUBMITTED

Return registration form along with appropriate documents to the Parking Division at 243 N. Center, Suite 202, San Antonio, TX 78202 or fax to (210) 886-0025 Attn: Parking Enforcement Section. If you require addition information concerning this program, call the Parking Division at (210) 207-8277.

FOR OFFICIAL USE ONLY

Permit # Date Issued Expiration Date

Amount Paid Cash/MO Receipt # Check #

Pick Up Picked up by (Print) Delivery by Certified Mail

Application Form

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