VENDOR DELIVERY PARKING PERMIT APPLICATION

Print Form

VENDOR DELIVERY PARKING PERMIT APPLICATION BUSINESS INFORMATION

Legal Name of Company: Business Name (DBA): Address: State:

City:

Zip:

BTRC No.: CONTACT INFORMATION

Title:

Primary Contact Name: Address: State:

City: Phone No.:

Fax No. :

Zip: Email:

OPERATIONAL INFORMATION

Completion Date:

Start Date: Description of service(s) to be provided:

Delivery Day(s): Terminal Location(s):

Su T1

T2

M

T T3

W T4

Th T5

T6

Sa Delivery Time(s):

F T7

T8

TBIT

Cargo Other:

CERTIFICATION BY HIGHEST RANKING LOCAL OFFICIAL

Highest Ranking Local Official : Phone No.:

Title: Fax No. :

Email: Date:

Signature:

Vendor Permit Application

Page 1 of 2

Revised 9/27/2011

SERVICES PROVIDED TO: (Complete one section for each company serviced at LAX) Company Name: Title:

Company Contact : Phone No.:

Fax No. :

Email:

Type of service(s) provided: Delivery Day(s): Terminal Location(s):

T1

Su

M

T2

T

W

T3

T4

Th T5

Sa Delivery Time(s):

F

T6

T7

T8

TBIT

Cargo Other:

FOR OFFICE USE ONLY Verification Letter Received

Comments:

Company Name: Title:

Company Contact : Phone No.:

Fax No. :

Email:

Type of service(s) provided: Delivery Day(s): Terminal Location(s):

T1

Su

M

T2

T T3

W T4

Th T5

Sa Delivery Time(s):

F

T6

T7

T8

TBIT

Cargo Other:

FOR OFFICE USE ONLY Verification Letter Received

Comments:

Company Name: Title:

Company Contact : Phone No.:

Fax No. :

Email:

Type of service(s) provided: Delivery Day(s): Terminal Location(s):

T1

Su

M

T2

T T3

W T4

Th T5

T6

Sa Delivery Time(s):

F T7

T8

TBIT

Cargo Other:

FOR OFFICE USE ONLY Verification Letter Received

Comments:

Make copies if additional sheets are needed and attach to application. Vendor Permit Application

Page 2 of 2

Revised 9/27/2011