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2. After setting up your Parkmobile account, please complete this form to be eligible for a waiver from the $.35 cents Parkmobile transaction fee. Only residents of the Town of Palm Beach are eligible to receive this waiver.
4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Mobile Number Linked to Parkmobile Account*
16. Email Address Linked to Parkmobile Account*
18. CERTIFICATION OF RESIDENCY: Be submitting this application you are certifying that the information you have provided is accurate and you are verifying that you are a resident of the Town of Palm Beach.
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit Submit and Print

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