On-site event contact name/phone number

Department:

Campus Address:

Campus Phone:                 Campus Fax:

Email:

Check all that apply:      Take meters out of service           Street Closure   

 Detailed purpose for closure/meters to be taken out of service:

Date(s) and Time(s): beginning & end, including set-up and tear-down of event:

 Exact location (s), including street name and address:

Meter number(s) (Meter numbers are visible on the glass portion of the parking meters, please do not provide the bar code number usually beginning with an "H."):

University account number to be charged, your account will be charged $10 per meter per day: