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ACH or Credit Card Authorization

  1. Instructions

    Fill out and submit or print this form. It should be submitted to the Parking Services Office along with the Parking Permit application and Permit Parking agreement. You must come into the Parking Service Office to complete the application process and receive your parking supplies. If you currently have a parking permit with the city and would like to start recurring payments, please complete the form below and check the COL authorization box.

  2. Contact Us

    If you desire assistance or have questions about this form you can email us at or call us at (517) 483-4240, or visit us at the Parking Office at 219 N. Grand Ave. Lansing, MI 48933 M-F 8:00 am - 4:30 pm.

  3. Personal Info

  4. Recurring Payments

  5. COL authorization

    I am a current COL parking permit customer. Your recurring charge will start on the 1st business day of the next month.

  6. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  7. Credit Card Authorization

  8. Credit Card Authorization

  9. Automatic Bank Withdrawal Authorization (ACH)

  10. For office Use ONLY

  11. RP#:

  12. Permit:

  13. Amount:

  14. Start Date:

  15. Leave This Blank:

  16. This field is not part of the form submission.