J. Sargeant Reynolds Community College
CUSTOMER SHORTAGE APPEAL FORM
 
The Customer Shortage Appeal Form must be filed within a period of five (5) business days, inclusive of the date on which the shortage occurred.
 
 
 APPEAL OF CUSTOMER SHORTAGE#:       DATE ISSUED:  Pick a date (mm/dd/yyyy)     DECAL#  
 
 DECAL TYPE:     FACULTY     STAFF     STUDENT     VISITOR
 
 EMPL ID#:    
 Name:      Drivers License Number #:  (no dashes)
 License Plate No.       State of Registration  
 
(Please specify mailing address to which notifications/information should be forwarded)
 
 Street Address:   
 City:                        State:      Zip:  
 Telephone:           (###-###-####)    Alternate Phone:   (###-###-####)
 
 I REQUEST A REVIEW OF THE ABOVE REFERENCED CUSTOMER SHORTAGE FOR THE REASON STATED BELOW.
 
  I CERTIFY THAT THE ABOVE STATEMENT IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I HAVE BEEN INFORMED OF THE PARKING RULES AND REGULATIONS REGARDING THE PARKING DECK AND AGREE TO ABIDE BY SAID RULES AND REGULATIONS IN THE FUTURE. FURTHERMORE, I UNDERSTAND THAT FUTURE OCCURANCES SIMILAR TO THAT APPEALED ABOVE WILL RESULT IN THE ENFORCEMENT OF PARKING CHARGES AND AN APPEAL OF SUCH PARKING CHARGES WILL NOT BE CONSIDERED.
(checking this box implies your signature on the appeal application)
 
For Office Use Only
 
________________________________________________________________             ____/_____/____
                                               Parking Services Manager                                                                Date
 
________________________________________________________________             ____/_____/____
                                               Director, FM&P (Initials)                                                                 Date
 
 
   Appeal Granted   Appeal Denied
 
   Reason:     Multiple Offense(s)            Missed Submission Deadline            Other:________________________________________
   
 

       

JSR Form 70-0047   Revised 6/2011