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San Rafael
Protecting San Rafael from wildfire is a team effort, we need your help. Take a look at our Wildfire Safety Action Plan and
let us know what you think
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Single Card Account Application for Recurring Payments
I am requesting:
*
Required
Monthly Parking C Street Garage
Are you a current Monthly Parking Cardholder?
*
Required
Yes, I already possess an active Parking Card
No, I am applying for a brand new account
Account Information:
Account Name (or Contact Name)
*
Required
First
Last
Business Name
If different from above.
Email (for Account Contact)
*
Required
Phone (for Account Contact)
*
Required
Billing Address
*
Required
Street Address
Address Line 2
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Armed Forces Americas
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Is the credit cardholder name different from the Account/Business Name for this account
*
Required
Yes
No
Name of Credit Cardholder
*
Required
First
Last
Check here if you will park overnight on a regular basis (11pm – 6am)
Vehicle information
License Plate
Make
Model
Color
Please add additional rows for each vehicle that will be parked overnight.
My new Parking Card:
*
Required
Hold my new Parking Card at the Parking Services office - I will come pick it up
I already have a Parking Card
Recurring Payments
*
Required
Price:
$73.00
Automatically charges your credit/debit card on the 5th of each month.
If you sign up between the 1st - 5th of the month, you will be charged on the 5th for that month.
If you sign up between the 6th - 15th, you will be charged on the date you fill out the form for this month. Then, your renewal payment will occur on the 5th for the next month.
If you sign up between the 16th and the last day of the month, your credit card will be charged on the upcoming 5th for the next month's charge.
Questions?
Read the Recurring Monthly Payments FAQ
.
Credit Card
*
Required
American Express
Discover
MasterCard
Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
Expiration Date
Security Code
Cardholder Name
Terms and Conditions
*
Required
By clicking 'Submit,' you
agree to these terms
and agree to sign up for automatic payments.
Questions?
Read the Recurring Monthly Payments FAQ
.
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