One-Day Parking Permit Book Order Form - Oregon Department Of Administrative Services

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Fleet & Parking Services
1100 Airport Rd SE
One-Day Parking Permit Book
Salem, OR 97301-6082
503-378-5090
Order Form
503-378-2157 fax
state.parking@oregon.gov
Instead of filling out this form, you can purchase One-
https://apps.oregon.gov/DAS/Storefront/
Day Parking Permit Books at our new online store!
Agency Number
Agency Name
Division/Section
Contact Name
:
Phone:
Address:
E-Mail:
One-Day Parking Permit Book (20 permits per book)
Total Order
Number of books:
X
$120 per book
: $
Payment Method
Prepaid Electronic Transfer: BT
Coding for SFMS Agencies:
One-Day Permit Book – TC 722/723, PCA 81900, AOBJ 1801, Project #/Phase 110098-00
Credit Card – Instead of filling out this form, use our online store:
https://apps.oregon.gov/DAS/Storefront/
Fax or email: we will call your office for credit card/SPOTS information
Check Number:
(attached)
Authorized Signature
Date
If you fax your order, please do not mail the original form. One-Day Permit Books will be mailed to the address listed on
this form unless you notify us that someone will pick up the order. Office hours: Monday through Friday, 8 a.m. to 5 p.m.
U:\PKG\Forms\OrderForm.docx
Updated 8/25/2017 ICD

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