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PLC:

4276

Agency:

incorporated village of laurel hollow

For:

permits

Phone:

516-692-8826

Address:

1492 laurel hollow road
syosset, new york 11791

*Required Field

Payment Information

*Name:

Middle:

*Last:

*Street Address:

*City:

*State:

*Zip:

*Email Address:

*Type of Permit:

$20 For Parking Permit 1 - Specify: Make, Color, License Plate #:

$20 For Parking Permit 2 - Specify: Make, Color, License Plate #:

$20 For Parking Permit 3 - Specify: Make, Color, License Plate #:

$40 For Boat Rack Permit 1 - Specify: Type (Kayak, Dinghy, etc),:

$60 For Boat Rack Permit 2 - Specify: Type (Kayak, Dinghy, etc), Length/Width:

*Phone #:

(### - ### - ####)

Payment Amount

*Payment Type:

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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