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This form must be submitted over a SSL (Secure Sockets Layer) connection.
Applicants are able to enter vehicle information for up-to two cars.
Please note that this does not permit the parking of two cars at the same time. Each parked car requires it's own permit.
Select the color that best represents the vehicle.
I have read and agree to park this vehicle in accordance with the ordinance and regulations of the Borough of Madison. I agree to park only in the designated permit area and comply with all rules and regulations, which includes parking head in only in the parking lots and displaying my permit from my rear view mirror. If I utilize this permit in connection with any use other than employment, I understand that I am subject to and will be responsible for any fines and/or penalties that may be incurred.
If any of the information I have given on this form is false, the permit will be revoked immediately.
Additionally, upon termination/resignation/retirement of my employment, I will surrender this permit to the Borough of Madison Personnel Department.
I am aware that I may be issued a summons if I display my placard prior to January 1, 2020.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
This field is not part of the form submission.
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