Link to: The University of Western Ontario Link to: Western Parking and Visitor Services




Commercial, Retiree or Other Permit Application Form



Statement of Agreement
Do you accept the Statement of Agreement as the terms and conditions of this parking permit?

* I Accept
        I DO NOT Accept (you will be redirected back to the parking homepage)


References
Rate Schedule, Permit Information, and Campus Parking Map



Mandatory information is indicated by a *

Your Status is: *

Commercial
Retiree
Other

Do you required Disabled Parking?

Ministry of Transportation Disability Permit Number:
Expiry Date:


Account Information
Please enter the following data to update/setup your parking account.

Your email address *:
Surname/Company Name *:
Firstname/Company Name *:
Initial:
Student/Employee Number :


Local Address Information
Local/Campus Address:
City/Building:
Province/State:
Postal Code:
Phone Number:


Home Address Information
Home Address*:
City *:
Province/State:*:
Postal Code *:
Phone Number *:



Vehicle Information

Vehicle 1* Vehicle 2 Vehicle 3
License Plate*: License Plate: License Plate:
Province/State*: Province/State: Province/State:
Vehicle Make*: Vehicle Make: Vehicle Make:
Vehicle Model*: Vehicle Model: Vehicle Model:
Vehicle Colour*: Vehicle Colour: Vehicle Colour:
Vehicle Type*: Vehicle Type: Vehicle Type:



Permit Information



Transponder Information

A $30.00 refundable deposit applies to the transponder purchase. Please choose *:

Yes, I need a Transponder

No, I already have a Transponder



Do you need a Motorcycle Permit?

Motorcycle Permit Required

Motorcycle Permit Not Required



Start and End Date of Permit Requested

Please indicate *:

Full Parking Year (1 September - August 31)

Other

If OTHER was selected above please indicate start and end dates*.

Start Date of Permit:
End Date of Permit:



Payment Method

Please select the following payment method.


Your application will be processed. The following payment methods (Cash, Cheque, Debit Card, Visa, Mastercard, American Express) are available via our main office in Room 4150, Support Services Building.



     

Online Payments are secured by:

Western Parking and Visitor Services is proud to be a member of the:
Ontario Campus Parking Assoc., Canadian Parking Assoc., International Parking Institute

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