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Employee Parking Access Card Application

2. City of Fredericksburg Employee Parking Access Card Application
   To obtain a City employee parking card, complete and submit this form. You will receive an email from the garage when your card is activated and ready to pick up. Please allow up to 48 hours for processing. For more information on the parking garage's location and hours of operation, see the Parking Garage page on the City of Fredericksburg website. If you have questions, please email FAaccounting@fredericksburgva.gov or call (540)372-1017.

   To obtain a City employee parking card, complete and submit this form. You will receive an email from the garage when your card is activated and ready to pick up. Please allow up to 48 hours for processing. For more information on the parking garage's location and hours of operation, see the Parking Garage page on the City of Fredericksburg website. If you have questions, please email FAaccounting@fredericksburgva.gov or call (540)372-1017.

4. First Name*

5. Last Name*

7. Home Phone Number*

8. Cell Phone Number*

9. Work Phone Number*

11. Home Email Address

12. Work Email Address*

14. Vehicle #1 Make*

15. Year and Model*

16. License Plate No.*

17. State*

19. Vehicle #2 Make (Opt.)

20. Year and Model

21. License Plate No.

22. State

24. Emergency Contact*

25. Phone Number*

27. Name of City Department or Agency*
    -- Select One --City Manager's OfficeHuman ResourcesCity AttorneyCommissioner of RevenueTreasurerFiscal AffairsInformation TechnologySafetyRegistrarCircuit CourtClerk of Circuit CourtSheriffCommonwealth AttorneyFirePublic WorksPlanningEconomic Development and TourismBuilding ServicesJDR CourtGeneral District CourtOther

28. Current parking card number, if applicable

32. Processed By:

33. Card Number:

35. Date:
    Date:

36. Effective Date
    Effective Date

37. Termination Date
    Termination Date

39. Signed and Dated by Department Head:

    I hereby approve the monthly parking access card for this employee.

41. Signed and Dated by Cardholder:

    I hereby acknowledge receipt of the monthly parking access card and monthly parking agreement. I agree to all terms and conditions set forth in said agreement.

Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

* indicates a required field