An automatic charge of your monthly parking fee will be deducted from your on-file credit card on the 3rd day of each month. Should you wish to discontinue use of this payment method, you must submit notice in writing 10 days prior to cancellation.

Print this page, fill it out, attach the required documents, then drop the forms off at our Kings County Parking headquarters »

Credit Card Type:

(circle one)
Visa | MasterCard | Discover

Credit Card #: _____________________________________________________
Expiration Date: ___ / ___

Please attach a photocopy of:

• DRIVER’S LICENSE
• EMPLOYEE HOSPITAL I.D.
• SIGNED CREDIT CARD IMPRINT

I hereby authorize “KINGS COUNTY PARKING LLC” to charge my monthly parking fee on my credit card. I understand full payment of my monthly parking fee is due on the first of every month and will be charged on the 3rd day of every month. If my credit card is denied for any reason I will be charged an additional $15.00 for that month. If I continue to park my vehicle on the campus after various attempts to contact me KINGS COUNTY PARKING reserves the right to boot or have my vehicle towed for non-payment after following appropriate procedure under the guidelines afforded to us by KINGS COUNTY PARKING and the City of New York. I understand that I am personally guaranteeing payment for all charges and authorize Kings County Parking to charge my credit card.

Signed

X_______________________________________________________________

Print this page, fill it out, attach the required documents, then drop the forms off at our Kings County Parking headquarters:

Kings County Parking
451 Clarkson Avenue Brooklyn
New York 11203
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