Citation Number (5 digits - top right corner)

Citation number is required.

Date citation was issued

Citation date is required.

First name

Valid first name is required.

Last name

Valid last name is required.

Are you a current Student at Capital University? No Yes

Are you a current Faculty/Staff member at Capital University? No Yes

Capital University ID Number

Capital University Mailbox Number

Email (Optional)

Please enter a valid email address.

Phone

Please enter a valid phone number.

Make

Please enter your vehicle's make.

Model

Please enter your vehicle's model.

Year

Please enter your vehicle's year.

Color

Please enter your vehicle's color.

License Plate Number

Please enter your vehicle's license plate number.

License Plate State

Please enter your vehicle's year.

Please enter your shipping address.

City

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State

Please select your state.

Zip

Zip code required.

Parking in a Handicap Space without a Permit