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

BOOK A PARKING RESERVATION

Disabled Veterans Online Discount Enrollment Form

Disabled Veterans Online Discount Enrollment Form

Disabled Veterans Online Discount Enrollment Form