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<br />TO REGISTER PLEASE FILL OUT, SIGN AND RETURN THIS FORM <br /> <br />Please provide ALL requested information, including data on up to five vehicles. Mail form to City <br />of Santa Ana, Community Development Agency (M-25), P.O. Box 1988,Santa Ana, CA 92701, <br />Attention "Administrative Services Division." <br /> <br />Name: First: <br /> <br />MI: <br /> <br />Last: <br /> <br />Company <br />Name: <br /> <br />Street <br /> <br />City <br /> <br />State <br /> <br />Zip <br /> <br />Mailing Address <br /> <br />Phones: <br /> <br />Home <br /> <br />Work <br /> <br />Mobil <br /> <br />Please circle one <br />Automobile(s): Make / Model Add/Delete <br /> <br />License Plate <br /> <br />State <br /> <br />Color <br /> <br />A) <br /> <br />Please circle one <br />Automobile(s): Make / Model Add/Delete <br /> <br />License Plate <br /> <br />State <br /> <br />Color <br /> <br />B) <br /> <br />Please circle one <br />Automobile(s): Make / Model Add/Delete <br /> <br />License Plate <br /> <br />State <br /> <br />Color <br /> <br />C) <br /> <br />Please circle one <br />Automobile(s): Make / Model Add/Delete <br /> <br />License Plate <br /> <br />State <br /> <br />Color <br /> <br />B) <br /> <br />Please circle one <br />Automobile(s): Make / Model Add/Delete <br /> <br />License Plate <br /> <br />State <br /> <br />Color <br /> <br />C) <br /> <br />THIS CONTRACT LIMITS OUR LIABILITY READ IT <br />Customer leaves car at his own risk. This proximity card licenses the holder to park ONE AUTOMOBILE in <br />this garage in the area designated by the operator. PARK PROPERLY and LOCK YOUR CAR! Only rental <br />space license is granted and no bailment is created. <br />The City of Santa Ana, our employees, agents. officers, and assigns assume no liability and shall not be <br />responsible for thefts, collision, fire, flood or damage in any case to said automobile or any other article left <br />in same. We shall not be responsible for articles left in car. No employee or agent may alter or enlarge our <br />liability hereunder orally or othelWise. This constitutes the entire contract and your signature below <br />constitutes acknowledgement by patron that you have read and agree to the foregoing. <br /> <br />Signature <br /> <br />Date <br /> <br />For Office Use Only <br /> <br />Exhibit B <br />