Thomas Jefferson University Commuter Services Office

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Remote Parking Application




* First Name:


* Last Name:


* E-mail Address


* Department:


* Work Telephone:


Work Hours:


* Employee Number:


* Work Office Building/Room:


Fields marked with an asterisk * are required and must be entered.

By submitting this form, I authorize the Payroll Department to deduct $100.00 from my standard first pay of each month.  I understand that canceling this service requires written/email notice 30 days before the end of the month.  I also understand that there will be no refunds for partial months or non-use of this service.  If my employee status changes (i.e., leave of absence, disability, termination, etc), I am responsible for notifying CSO immediately.  If for any reason my employment should end before the completion of my payment(s), I agree to make final payment(s) for these services by check, cash, or credit card.

If the fee for this service is increased in the future, my payroll deduction/credit card for monthly remote parking will be increased accordingly.

I understand and agree that parking in this facility will be at my own risk. Neither DLC or TJU are responsible for any damage or loss due to fire, theft, collision, vandalism, or otherwise to my vehicle and its contents while my vehicle is parked in this facility.


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