Handicap Parking Request Form Template

Use the Handicap Parking Request Form to collect the information on handicapped people to provide them a special parking facility.

Handicap Parking Request Form

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First Name

Middle Name

Last Name

Mailing Address

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone

Date of Birth

Email Address

Driver License Number

Application Type

Permanent Placard

Temporary Placard

Travel Parking Placard

Disabled Person License Plate

License Plate Number

Vehicle Identification Number (VIN)

Vehicle Make

Vehicle Year

Please attach document from state licensed medical physician to certify disability.

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The information I have entered is truthful to the best of my knowledge.

About this template...

Handicap Parking Request Forms are used to collect the information about the disabled person to give them permission to special privileges on the parking of their vehicle.

Features of this Template

Name
Mailing address
Address
Phone
Date of birth
Email
Driver license number
Application type
Attach a document from a state-licensed medical physician to certify the disability.