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State Vehicle Permit Application
State Vehicle Permit Application
Department Name
(Required)
Department Head/Chair
(Required)
Department Number
(Required)
Department CB#
(Required)
Department Parking Coordinator
(Required)
Coordinator Email Address
(Required)
Phone Number
(Required)
Action requested
(Required)
Request new permit
Cancel permit
How many permits is your department requesting?
(Required)
Please explain the need for these permits (use of the state vehicle). If more than one permit is requested, state the reason multiple permits are required.
(Required)
Vehicle Information
(Required)
License Plate Number
State Vehicle Number
Vehicle Make/Model
Vehicle Color
Add
Remove
Cancel Permit
(Required)
License Plate Number
Add
Remove
Method of Payment
(Required)
Check
Credit Card (Visa/Mastercard/Discover)
Direct Transfer
PSoft Number
(Required)
Departments paying by Direct Transfer will be processed within 72 hours after the date of services and reflected in the monthly Customer Billing management (CBM) notification. Services paid for by credit card will be billed after the date of services.
State Vehicle Permit Guidelines and Restrictions
(Required)
I understand
I understand that the department will be charged the
current annual rate
for each permit issued. If the permit(s) is misused, it may result in fines, penalty, or revocation. I agree to contact Transportation and Parking if the permit(s) is lost, stolen, or destroyed and understand that a replacement fee may be charged.
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