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2. 
3. 
5. First Name
6. Last Name
8. Street Address (must be within City of Summit)
10. Email Address (must be same as Lyft/Uber account)
12. Cell Phone Number
13. License Plate (to confirm parking permit)*
14. *In order to be considered eligible for this program, applicants must have a Summit parking permit.
16. I am a:*

    Please choose one.

    1. Prepaid Parker
    2. Daily Parker
17. Please note: If you are a daily parker the $4 fee will be charged through Lyft/Uber. If you are a prepaid parker there will be a $2 fee charged to you. Pre-payment must be received by the City of Summit by the first of the month, quarter, or year.
19. In what lot or garage do you currently park?*

    1. Broad St. Garage
    2. Broad St. East Lot
    3. Elm St. Lot
    4. Sampson Lot

    1. Chestnut Lot
    2. Park & Ride
    3. Tier Garage
    4. Other
20. What time(s) do you commute to and from the Summit Train Station?
22. On what days of the week do you commute?*

    Select all that apply.

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
25. Are you a Summit resident who works downtown?

    1. Yes
    2. No
27. Downtown Business Name
29. Downtown Business Address
31. Downtown Business Phone Number
33. Participants will receive door-to-door service to and from downtown Summit in a Lyft or Uber vehicle.
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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit Submit and Print

* indicates a required field