Henderson Baptist Church
Car Park Lease Form
Name
*
First Name
Last Name
Work Email
*
example@example.com
Do you work for Te Whanau o Waipareira?
Yes
No
Address
*
Street Address
Street Address Line 2
Suburb
City
Post Code
Work Number
*
-
Area Code
Phone Number
Personal Number
*
-
Area Code
Phone Number
Personal Email
*
example@example.com
Vehicle Registration Number
*
Vehicle Make/Colour
*
example: Red Mazda
Additional Vehicle Registration Numbers
This is important if you drive more than one car as spaces are enforced
Company Name
I want to start parking from:
*
-
Day
-
Month
Year
Date Picker Icon
I want to finish parking on: (If known)
/
Day
/
Month
Year
Date Picker Icon
I will pay for my carpark via:
*
Fill me in
Fortnightly Direct Debt
Weekly Direct Debt
Fortnightly Automatic Payment
Monthly by Automatic Payment
Please note Direct Debt is a new option. Previously regular payments have been made via automatic payment.
Signature
Dated
*
/
Day
/
Month
Year
Date Picker Icon
Submit
Should be Empty: