Student Parking Registration Form | Benedict College

Driver's Name*
First Last
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home/Cell Phone*
Vehicle Make/Model*
Vehicle Color*
How many doors?*
License Plate Number*
License Plate State*
Upload copy of Driver's License, Registration, and Proof of Insurance*
Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 200 MB.
Student Parking Decal Fee - Fall Semester Quantity*
Price: $50.00
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Student Signature*
CAPTCHA

Driver's Name*
First Last
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home/Cell Phone*
Vehicle Make/Model*
Vehicle Color*
How many doors?*
License Plate Number*
License Plate State*
Upload copy of Driver's License, Registration, and Proof of Insurance*
Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 200 MB.
Student Parking Decal Fee - Fall Semester Quantity*
Price: $50.00
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Student Signature*
CAPTCHA