Third Party Authorization Form Sample

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Third Party Authorization Form
Date: _________________________________
Attn:
Parking & Transportation Services
3359 Mississauga Road North
Mississauga, Ontario, L5L 1C6
T: 905-828-5254
I, ___________________________________________, student #________________________
authorize _______________________________________________________ to:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Signed,
___________________________________________
OFFICE USE ONLY:
*Remember to sign your completed application form
DATE RECEIVED

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