Disabled Veterans Online Discount Enrollment Form

I certify that I am a Disabled Veteran with a minimum of 50% service-related disability or a Purple Heart Recipient.

Yes

I certify that I am a requesting a parking space for myself as a disabled veteran and not for the use of another person.

Yes

Name(Required)

First Name Last Name

Address

Address 1 Address 2 City State Zip

Upload supporting document(Required)

Max. file size: 100 MB.

Upload Award Letter showing service-connected disability of 50% or higher OR DD-214 showing that the individual was a recipient of a Purple Heart Medal.

Identification Documentation(Required)

Max. file size: 100 MB.

Drivers license or state-issued ID must match the name on the DD-214 or Award Letter.

Email Copy

Receive an email copy of this form.

Email address

This field is not part of the form submission.

Signature

Park Smart. Reserve Today

Disabled Veterans Online Discount Enrollment Form

Disabled Veterans Online Discount Enrollment Form

Disabled Veterans Online Discount Enrollment Form