2. Business Name
3. Address
   Riverside, IL 60546
5. Phone Number
6. Email*
8. Owner(s)
9. Manager(s)
11. Business owners must apply for employee parking permits. Parking permits are renewed quarterly and allow employees to park in designated Lot 10 spaces only during shift hours.
13. Employee Name
14. Vehicle Make/Model
15. Plate #
16. Permit #
18. Employee Name
19. Vehicle Make/Model
20. Plate #
21. Permit #
23. Employee Name
24. Vehicle Make/Model
25. Plate #
26. Permit #
28. 1. Add another employee
30. Employee Name
31. Vehicle Make/Model
32. Plate #
33. Permit #
35. 1. Add another employee
37. Employee Name
38. Vehicle Make/Model
39. Plate #
40. Permit #
42. 1. Add another employee
44. Employee Name
45. Vehicle Make/Model
46. Plate #
47. Permit #
49. 1. Add another employee
51. Employee Name
52. Vehicle Make/Model
53. Plate #
54. Permit #
56. 1. Add another employee
58. Employee Name
59. Vehicle Make/Model
60. Plate #
61. Permit #
63. Electronic Signature Agreement*

    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.

    
    

    I understand and agree to the following terms and conditions, and I will ensure that my employees understand and abide by them as well:

    • Parking permits are provided by the Village of Riverside at no charge.
    • Only owners and managers are allowed to register employee vehicles.
    • New permits will be issued quartely, an updated employee list must be provided every quarter.
    • These parking permits are only to be used by employees while they are working at the above named business. Permits may not be sold, transferred, borrowed or otherwise given to anyone else.
    • The permit must be permanently affixed to the rear window of the vehicle to which it is issued.
    • Parking spaces will not be assigned. No backing into stalls.
    • No parking allowed between 2am and 5am.
    • The Village will not be responsible for loss or damage to any vehicle or its contents.

    
    

    1. I agree.
65. Electronic Signature
Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit

* indicates a required field