Agency/vendor Parking Application - Oregon Department Of Administrative Services

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Fleet & Parking Services
1100 Airport Rd SE
Salem, OR 97301-6082
503-378-5090
Agency/Vendor Parking Application
503-378-2157 fax
state.parking@oregon.gov
Please print clearly
Agency/Vendor Name:
Agency Number:
Division/Section:
Business Address:
Contact Name:
Work Phone #:
Email:
nd
2
Contact Name:
Work Phone #:
Email:
Billing Contact Name:
Billing Phone #:
Email:
Billing address:
Vehicle description
Vehicle # 1 – Make /Model:
State:
Plate:
Vehicle # 2 – Make /Model:
State:
Plate:
Vehicle # 3 – Make /Model:
State:
Plate:
Payment:
□ Invoice - State agencies and vendors are billed monthly in arrears.
We understand that parking regulated by the Department of Administrative Services is subject to the provisions of OAR Chapter 125,
and ORS Chapters 98, 276, 283, and 292. By accepting any parking assignment made by the Department, agency personnel agree to
abide by these rules and laws. We further understand that failure to abide by these rules and laws by any agency personnel may result
in citation, prosecution and/or loss of agency vehicle parking privileges.
Signature:
Date:
FOR OFFICE USE ONLY
Lot Assigned/Space Number:
Monthly Rate:
Effective Date:
Record Number:
U:\PKG\Forms\Agency_Application.docx
Updated 8/25/2017 ICD

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