Home Parking Permit Application Parking Permit Application "*" indicates required fields Step 1 of 4 25% Provide Parker InformationName* First Last Employer* Work Location* Home Address* Street Address City ZIP Code Phone*Requested Start Date* Provide Vehicle InformationMake* Model* Plate #* Color* Will you be using the Electric Vehicle Charging Stations?* Yes No Preferred Location and Permit TypePlease Note: Some locations and permits may be limited based on availability or employer. If your preferred location is not available, we may be able to offer an alternative location from the list below.Michigan Goodrich Garage (Select your permit type) 24/7 All Access: $99 per month Overnight (6 PM – 8 AM only): $79 per month Debit by Hour: $0.75 per hour Reserved Space: $189 per month Carpool Pass*: $99 per month 854 Ellicott Street Garage (Select your permit type) 24/7 All Access: $99 per month Overnight (6 PM – 8 AM only): $79 per month Debit by Hour: $0.75 per hour Reserved Space: $189 per month Carpool Pass*: $99 per month 589 Ellicott Street Surface Lot (Select your permit type) 24/7 All Access: $99 per month Carpool Pass*: $99 per month 847 Main Street Surface Lot (Select your permit type) 24/7 All Access: $99 per month 73-85 High Street Surface Lot (Select your permit type) 24/7 All Access: $99 per month Carpool Pass: check here if you have a carpool partner Yes * Eligible if you drive to work and park with a coworker at least 3 days per week. Review Payment-Processing InformationOnce your application has been approved, you will be contacted to provide your credit card information so that we can process payments. You will also be assessed a one-time, non-refundable activation fee of $10 plus a $10 refundable deposit on the permit hangtag. You will then receive an email to set up your account at the email address you listed above. The account will allow you to manage your payment and permit preferences. Note: For payroll deduction, please speak to your employer about eligibility and setting up your deductions.Review Terms and ConditionsConsent*The following are the required terms and conditions for the monthly parking permit agreement (this “Monthly Agreement”) with the Buffalo Niagara Medical Campus, Inc., its affiliates and subsidiaries (134 High Street, LLC, 854 Ellicott St., LLC, 589 Ellicott Street, LLC, 73 High Street, LLC and 960 Ellicott Street, LLC). Buffalo Niagara Medical Campus, Inc. and the entities referenced in the preceding sentence shall collectively be referred to as “BNMC.” “You” and “Your” shall collectively refer to the individual customer executing this Monthly Agreement. All terms and conditions are subject to change without notice. Payment is due by the 1st business day of the month. Any outstanding accounts on the 5th day of the month will be charged a $15.00 late fee. BNMC reserves the right to suspend or cancel the Monthly Agreement at any time and/or tow vehicle (at Your expense) if You are in breach of the terms and conditions herein. BNMC also reserves the right to charge You the daily rate for breach of the terms of this Monthly Agreement. BNMC reserves the right to suspend or cancel this Monthly Agreement at any time, for any or no reason. Forms of payment accepted: Mastercard, Visa, Discover, Amex, and debit card payments will only be accepted through the provided online portal or by calling BNMC’s main office directly for instructions. DO NOT fax or mail account numbers or card information. At each BNMC location, each monthly parking account will be assessed a one-time, non-refundable ACTIVATION FEE of ten dollars ($10.00) plus a ten-dollar ($10.00) REFUNDABLE DEPOSIT on the permit hangtag. The activation fee includes the cost of account set-up. If any hangtag is damaged through no fault of Your own, it will be replaced free of charge upon return to BNMC. If a hangtag is lost or stolen, a new hangtag will be issued upon the payment of a twenty-five dollar ($25.00) replacement charge. Upon cancellation, hands-free hangtags are to be returned to BNMC in good working order within thirty (30) days and You will be mailed the ten dollar ($10.00) refundable deposit. Cancellation of this Monthly Parking Agreement must be submitted in writing, by mail, e-mail, or fax, and sent to BNMC’s attention at 640 Ellicott Street, Suite 400, Buffalo, New York 14203, at least ten (10) business days prior to effective calendar month or You will be responsible for all applicable payments. Notification of cancellation by telephone will not be accepted. BNMC does not issue refunds if cancellation takes place in the effective month. Monthly Parking Permits are issued on a calendar-month basis. NO REFUNDS, IN WHOLE OR IN PART, SHALL BE ISSUED AT ANY TIME. Parking rates and/or terms and conditions may be subject to change, and such changes shall be posted in full view at the location 10 days prior to any such change taking effect. BNMC is not obligated to individually notify You of rate or terms-and-conditions changes. Monthly parking does not guarantee the availability of a space, although every effort will be made to accommodate parking (it may be necessary to leave Your ignition key). Should no space be available, please see attendant for alternative parking. Parking is permitted only in those spaces or areas that are NOT designated as reserved or restricted use unless You have paid for or qualify for same. If You park in a reserved space not Your own, or a restricted area for which You do not qualify, You may be issued a fifty-dollar ($50.00) parking violation and/or have Your vehicle towed. Repeated occurrences may result in termination of this Monthly Agreement as determined in BNMC’s sole discretion. Monthly hangtags must be clearly displayed at all times from the rearview mirror on the front windshield of the vehicle, or as otherwise directed by BNMC, so that the numbers are visible from outside the vehicle. Any vehicle not displaying a monthly hangtag will be subject to pay the posted daily rate. Transfer of a monthly hangtag to another vehicle is prohibited. Transfer of a monthly hangtag to another person is also prohibited. Violation of this policy may result in termination of this Monthly Agreement as determined in BNMC’s sole discretion. Hangtag permits are only valid for the location for which they are designated. If the same hangtag number is found on more than one vehicle, or if a hangtag is used to admit more than one vehicle at a time to the parking facility, or if any misuse is determined, that hangtag permit will automatically be deemed invalid without refund. Parking patrons must park within one space as designated by the yellow lines. Parking patrons must also obey other location-specific regulations such as compact-car spaces, no-parking zones, handicapped-designated spaces, electric vehicle charging spaces, etc. Vehicles are not permitted to block entrances, exits, fire lanes, or other parked cars. BNMC RESERVES THE RIGHT TO ASSIGN A PARKING SPACE OR ASSIGN A PARKING LEVEL. Violating these rules will result in violation tickets and/or towing at Your expense. This Monthly Agreement is for the licensed use of a parking space only and BNMC is not responsible for any loss or damage to the vehicle or its contents caused by fire, theft, collision, or any other cause. Vehicles left unattended for twenty-four (24) hours or more are subject to removal at the sole discretion of BNMC. WARNING: VEHICLES SHOULD ALWAYS BE LOCKED, AND THE CONTENTS THEREOF SECURED IN THE TRUNK OR OTHER LOCKED STORAGE AREA OF THE VEHICLE. I have fully read and agree to the above monthly parking permit agreement.