Accessible Parking Space Assignment Contract
Date:
Parking Facility Name:
Facility Address:
Assigned Party Information
Name:
Residential Address:
Phone:
Email:
Disability Permit/Placard Number:
Vehicle Make & Model:
License Plate Number:
Parking Space Assignment
Space Number/ID:
Location/Section:
Assignment Start Date:
Assignment End Date:
Terms & Conditions
The assigned accessible parking space is for the exclusive use of the above-named party and vehicle only.
Display of a valid disability parking permit/placard is required at all times.
The assigned space must not be transferred, sublet, or used by unauthorized vehicles.
Violations may result in revocation of parking privileges.
All facility rules and regulations apply.
Assigned Party Signature:
Date:
Facility Representative Signature:
Date: