Application form for an on-street disabled persons' parking bay (Vehicle Driver)

• You must be the driver of the vehicle to apply.
• You must be a blue badge holder.
• You must live at the address where you want the parking bay.
• Passengers can only apply in exceptional circumstances.

We will treat all information provided in confidence and in accordance with our privacy notice.

The fields marked with an asterisk (*) are required fields. All the information you enter will be submitted securely.

* Your Name

* Address and postcode

* Contact telephone/minicom number

* Email Address

* Confirm Email Address

Email addresses do not match.

* Your Blue Badge number

* What is your vehicle make, model and registration number?

* Please tell us what difficulties you have in trying to park your car outside your home

* How does not being able to park close to your home affect you?

Is there a particular time of the day that you are unable to park close to your property?

Declaration

* I confirm that I am a blue badge holder and would like to have a disabled persons' parking bay outside my home.

I Agree