CITY OF PATERSON
PARKING AUTHORITY

Paterson Parking Authority Customer Information Form

DWAYNE COX
Chairman

ASHLEY TURNBULL
Vice Chairman

JENNY M. FORMENTIN
Secretary

REV. FABIAN HERAH
Asst. Secretary

REV. KENNETH CLAYTON
Treasurer

VENTURA PADILLA
Asst. Treasurer

WILFREDO CARRILLO
Commissioner

TONY PEREZ
Executive Director

GLENN F. SCOTLAND
General Counsel

Dear Customer:

Please take a moment to help us update our records; this will help expedite our transaction time in assisting you.
Please fill in all the fields below, this information is necessary for the Parking Authority's records. This information will also help to locate you in case there is an emergency with your vehicle while parked in our facility.

Thank you for your assistance.

Your Information:

Last Name/First Name:

Entity/Company Name:

Street

City State Zip

Phone # Day Cell

Fax#

Vehicle Information: Vehicle#1:

License Plate#:

Vehicle Make:

Vehicle Year:

Vehicle Model:

Vehicle Color:

To add additional vehicles please continue to

125 BROADWAY SUITE 100. PATERSON, NEW JERSEY 07505
(973)977-3999. FAX (973)977-8039. TOLL FREE: 1-877-250-3255. EMAIL:PATERSONPARKING@MSN.COM