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CARPOOL PARKING APPLICATION
(This is not an on-line application. However, you can type in the boxes provided, print, and send the application) |
| CSS USE ONLY:
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| ALL MEMBERS OF THE CARPOOL MOST RESISTER WITH THE COMMUTER SERVICES OFFICE AND OBTAIN A VALIDATED CARPOOL APPLICATION.
A CARPOOL MUST CONSIST OF TWO (2) 0R MORE PERSONS, COMMUTING A MINIMUM OF THREE (3) DAYS PER WEEK.
THE COMPLETED, VALIDATED APPLICATION MUST BE PRESENTED IN PERSON TO THE PERMIT SALES OFFICE. |
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| CERTIFICATION:
I certify that I am the principal driver of the carpool with the Individuals indicated in this application and that I commute to and from work with them on a regular basis, a minimum of three (3) days a week. Should any changes occur (additions, deletions or replacements), I agree to notify the Commuter Services Office Immediately. I have read and agree to abide by the Preferential Carpool Permit Program Rules with the understanding that violations on my part may result in the cancellation of the permit. I acknowledge that should any of the information relating to the carpool of which I am a member be found to be untrue, the carpool's special parking privileges will be revoked. I understand that this permit is valid only at the designated facility in specifically assigned CARPOOL areas or at any Long Term (9 hours or more) meters within the designated facility.
| Signature:_______________________________________ |
Date:__________________________ | |
Official Use Only:
| Control# _______________ |
Account# ________________ |
Fees $_________________ | |
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MONTGOMERY COUNTY, MARYLAND
PARKING SALES AND COLLECTIONS OFFICE
809 ELLSWORTH AVENUE (within Garage 61)
SILVER SPRING, MD 20910
MAIN: 240-777-8744 FAX: 301-565-5898 |
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