(Step 1) Department Vendor Permit Request

Faculty and Staff who have vendors needing to park may complete this form.

Please provide the UTA contact information.
Name Name * First Last
Division or College *
Department or Unit *
Construction Project? *

Construction Project? Yes- This is for a campus construction project No- This is not for a campus construction project
Phone Phone * - ### - ### ####
Your UTA Email Address *
Which Academic Semester should permit be valid for? *
Start Date of Service Contract Start Date of Service Contract * / MM / DD YYYY
End Date of Service Contract End Date of Service Contract * / MM / DD YYYY
Renew Permits *

Renew Permits Yes- contact me about renewing permits No- vendor service not expected to continue
What area(s) of campus will this vendor need access to? *

What area(s) of campus will this vendor need access to? Central Northwest Northeast Southwest Southeast West
How many vendor vehicles do you anticipate on campus at one time? *
I confirm the vendor company provided below has a professional relationship with the University of Texas at Arlington and is entitled to a vendor permit according to the current Parking & Transportation Rules & Regulations published at uta.edu/pats. *

I confirm the vendor company provided below has a professional relationship with the University of Texas at Arlington and is entitled to a vendor permit according to the current Parking & Transportation Rules & Regulations published at uta.edu/pats. I confirm the relationship with the University.
Please provide the Vendor's information.
Company Name *
Primary Vendor Contact's Name Primary Vendor Contact's Name * First Last
Primary Vendor Contact's Email

Please ensure email address is correct.
Primary Vendor Contact's Phone Number Primary Vendor Contact's Phone Number * - ### - ### ####
Additional Information PATS staff should know about this particular vendor

(Step 1) Department Vendor Permit Request

(Step 1) Department Vendor Permit Request

Please provide the UTA contact information.

Please provide the Vendor's information.