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: - - AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP Code: Daytime Phone: E-mail Address: Payment Information Payment Amount: Select Amount $600.00 - Annual Fee $300.00 - January 1st. to June 30th. $300.00 - July 1st. to December 31st. Payment Method: ACH Payment (e-Check) 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.