Harmon Lot Parking Permit

* Fields in red are required

Borough of Butler Harmon Lot Parking Permit Application

Full Name of Applicant:

Address of Applicant:

Address 2:

Home / Mobile Phone #:

Work Phone #:

Email Address:

Vehicle to be Parked

Vehicle Make:

Vehicle Model:

Vehicle Year:

Vehicle Color:

Vehicle VIN#:

Vehicle License Plate #:

How do you want to receive Permit: You will Pick up Permit at Butler Police Department

Have Permit Mailed to your Residence

Payer Information

Billing Name:

Address:

Address 2:

City:

State:

ZIP Code:

Daytime Phone:

Payer E-mail Address:

Payment Information

Payment Amount:

Payment Method:

Convenience Fee:

Enter information as it appears on your check (USA Banks Only)

Routing Number:

Account Number:

Re-Enter Account #:

Using the following lower portion of a personal check as an example, enter the information that appears at the bottom of your check. Do NOT include any dashes or spaces.

Comments:

Terms & Conditions:

By submitting this request I affirm that the information listed within this form and the information given is accurate and true. I also affirm that I understand the following rules:
1. Permits are available for non-commercial vehicles ONLY.
2. Permits are limited to Butler residents ONLY.
3. No more that two (2) permits per family.
4. Permits shall be non-refundable and non-transferable.
5. Permit parking shall be prohibited when snow plowing and/or parking lot maintenance is needed. We will attempt to contact you to move your vehicle for plowing and/or maintenance. Please note, it is your responsibility to remove your vehicle during such instances.
6. If you change vehicles during the permit year you must notify: Butler Police Records at: 973-838-4100 ext. 305

Parking Permits can take up to fourteen (14) full days to be completed and issued.

I agree to the above Terms and Conditions.

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