Citation Payment Plan

First Name * Last Name * Student/Staff ID # (If Applicable) License Plate # * Balance Owing * Citation Number(s) * Phone Number *

Voicemail Yes No

Email Address *

Please Select Payment Schedule For Citation Payment Plan: * Monthly Payments (due the by the 1st of every month) Bi-Weekly Payments

By applying for a Citation Payment Plan, it is considered an admission of guilt in relation to the included citation(s). Your application submission will hereby waive the right to further appeal these citations through the University of Regina or Provincial Bylaw Court. Do you accept the terms of application? * Yes No

Have you previously defaulted on a payment plan with Parking and Transportation Services * Yes No

Please be advised that a single missed payment will result in a defaulted Payment Plan and that the remaining balance will be due in full. Also if applicable your on campus parking privileges will be subject to suspension. If you are going to be late on a payment please contact Compliance and Citation Management to make arrangements. The balance owing will be divided into payment installments of no less than $25.00 per installment (with the exception of the final installment payment, if the balance remaining is less than $25.00); a Citation Payment Plan term will not exceed four months, if you have an excessive account balance an alternate payment schedule may be approved by University of Regina Parking and Transportation Services. * Yes No

Reason for Application *