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PARKING IS BASED UPON AVAILABILITY
PHONE EXTENSION #:
LAST NAME:
FIRST NAME:
ADDRESS:
LICENSE PLATE #:
YEAR:
VIN #: (Last 6 digits only)
MAKE:
MODEL:
COLOR:

By submitting this form, I certify the above to be correct and agree to abide by all rules and regulations pertaining to traffic, parking and motor vehicle registration contained in the Bloomfield College parking and traffic regulations which I have read and understand.
   
SIGNATURE:
DATE: