Car Parking Discount Season Ticket Application Form

					                     Car Parking Discount Season Ticket
                     Application Form
                     Community Services
Community Services Department                                                 Tel: 01629 761333
Town Hall, Bank Road                                                          Fax: 01629 761165
Matlock, Derbyshire. DE4 3NN                                                  email:

How to fill this form.
This application form is an interactive Adobe PDF form. It can be returned to the Council in three ways, by EMAIL, by POST, and by FAX.

How to send this form by EMAIL;
1. complete this form with your computer online or offline and save it to your computer with a name you can recognise and to a location
you can find easily e.g. My Documents.
2. once the form is complete send it back to the above email address as an attachment.

How to send this form by POST or FAX;
1. complete this form with your computer online or offline and save it to your computer with a name you can recognise and to a location
you can find easily e.g. My Documents.
2. once complete, print this form on your printer and then POST it or FAX it back to the relevant details above.

If you prefer to fill in this form by hand, print the form and then please complete the boxes in CAPITALS with a BLUE or BLACK pen.

1   Application Details.
                                                                                                       Leave blank if not applicable
    Correspondent Details.




    House Name or Number:

                Street Name:



    Contact Details.

        Daytime Telephone:

        Evening Telephone:



                                                               Page 1 of 4

2   Car Park or Designated Zones.
                                                                                                                              Olde English, Town Hall
                                     Bus Station, Cattle Market                                                               Front,    Bank Road,The
           ASHBOURNE                 ,Swimming Pool                                                    MATLOCK
                                     New Street, Agricultural                                                                 Station Yard, Temple Road
              BAKEWELL                                                                        MATLOCK BATH
                                     Business Centre                                                                          Artist Corner.

                 BASLOW                                                                         MONSAL HEAD                   ( Rear Only )

                     EYAM                                                                      OVER HADDON

          HARTINGTON                                                                            WIRKSWORTH                    Market Place
                                                                                                                              Barmote Croft


    VEHICLE REGISTRATION NUMBER(S)                      1st.                                           2nd

    TYPE OF TICKET REQUIRED:- 12 MONTHS (£200)                                              6 MONTHS (£100)

    IS TICKET BEING RENEWED ?                  Yes                           No
       If yes:
       Current Permit Serial No.                                                                         Expiry Date              /           /
       If no:
       New Permit to Start From:                                /            /

3   Method of Payment.
              ONLINE (Using e-Payments)                             Follow the link to the payment module after sending this form. Note a ticket will not be
                                                                    issued until a payment is made.
                                                                                                                              e-Payment Link
       CHEQUE/CASH/POSTAL ORDER                                     Payable to Derbyshire Dales District Council, do not send cash by post.

                                                                    We accept, Mastercard, Maestro VISA, VISA Elecron,Switch, Solo and
                                                                    JCB cards
                                                                    Please complete a Direct Debit mandate form, unless you are renewing an existing
              DIRECT DEBIT (MONTHLY)                                agreement. If you are an existing permit holder who pays by Direct Debit,you need
    Signature:                                                      not complete a new mandate
                                                                                         Date:                        Direct Debit Form Link

                                                                                                  /           /
     By signing this form I accept the terms and conditions of use attached to this form, pages 3 and 4. For email
     submissions, please type your full name here as a confirmation of signature.

    Data Protection Act 1998
    The information you put down on this form (called 'personal data' in the Act) will be put on Derbyshire Dales District Council's
    computer systems and will be processed for the purpose of helping with your application. Derbyshire Dales District Council may
    disclose your data to any person or organisation for this purpose or where the Act allows disclosure. Derbyshire Dales District
    Council may also use your data for its own market research purposes (but not for direct marketing). Derbyshire Dales District
    Council is the 'data controller' for this data, jointly with other partners with on-line access to the Partnership A to Z of Services
    Scheme. You have the right to ask Derbyshire Dales District Council for a copy of your data and for a description of how it is being
    used and to whom it is being disclosed.

    Freedom of Information Act 2000
    Information communicated to Derbyshire DalesDistrict Council may be disclosed to the public under the Freedom of information
    Act 2000.

    Other Types of Forms
    This form is available free of charge in paper, electronic, audio, Braille and large print versions and in other languages on
    request. For assistance in understanding or reading this document please call the number on top of the first page.
                                                                Page 2 of 4

4   Terms and Conditions.

                                                  INFORMATION SHEET


    The Discount Season Ticket Scheme is intended to assist those drivers who work within the main towns and
    villages of the Derbyshire Dales and who make use of pay and display car parks on a regular basis throughout
    the year.

    Tickets (in the form of a permit or badge) can be purchased for 6 or 12 month periods, at a cost which is
    equivalent to less than one days normal parking fee per week and, when displayed on the vehicle, will exempt the
    driver from having to pay at the ticket issuing machine. Ownership of a permit does not, however, guarantee you
    a space.

    Discount Season Tickets are available for most pay and display car parks controlled by the District Council
    although, in certain circumstances, restrictions may be in place. Exclusions from the scheme are short stay car
    parks, busy shoppers car parks and permit holders only car parks. A full summary of restrictions are given below.


    1. Season Tickets are not available for the following:
                           Short Stay Car Parks       Market Place, Bakewell
                                                      Market Place, Ashbourne
                                                      Monsal Head frontage (opposite Monsal Head Hotel)
                                                      Pavilion Matlock Bath
                                                      Imperial Road, (Somerfield rooftop) Matlock
                           Shoppers Car Park          Shawcroft, Ashbourne.

    2. The following restrictions are in place on market days: -
             BAKEWELL                                 Parking limited to grassland overspill areas on livestock market
             Agricultural Business Centre             days (Mondays, Thursdays and occasional Saturdays).
                                                      Attendants will be present to direct visitors to parking spaces on
                                                      such days.
             WIRKSWORTH – Market Place                No parking Tuesdays (prior to 7.00 pm).
             ASHBOURNE – Cattle Market                Parking is limited to the lower half of the site on market days
                                                      (Thursdays and Saturdays) from 6am to 6pm.

    3. The Council reserve the right to close any car park for a limited time for the purpose of carrying out
       maintenance work or repairs. In addition, certain car parks are closed for the purpose of staging public events.
       The following are regularly held: -
             Bakewell Agricultural Centre :           Bakewell Show – 5 days during early August
             Olde Englishe, Matlock:                  Victorian Christmas Market – first weekend in December
             Wirksworth Market Place:                 Well Dressing – weekend in late May
                                                      Arts Festival – weekend in September
             Hawkhill Road, Eyam:                     Carnival – weekend late August/early September
                                                      Bonfire Night – Saturday evening in November

    4. Tickets cannot be used in areas of car parks or specific bays which are otherwise reserved. Please be aware
       that whilst every effort will be made to offer alternative parking, the Council cannot guarantee you a space.


    The current fees for Season Tickets are £200 (12 month permit) or £100 (6 month permit), inclusive of VAT.
    Charges are subject to review but should remain unchanged for the period that any issued permit remains valid.

    Payment may be made in cash at any of the District Council’s Cash Offices, or by cheque or postal order made
    payable to ‘Derbyshire Dales District Council’. Alternatively, payment may be made by monthly direct debit.

                                                      Page 3 of 4

Terms and Conditions (page 2).


1.   Season Tickets are issued for specific cars and for specific parking areas (or zones) and are not
     interchangeable or transferable. A ticket holder must notify the Council of any changes in vehicle details, in
     order that a replacement permit may be issued. The original permit must be surrendered in exchange for a

2.   A season ticket holder may have the registration numbers of two cars stated on the season ticket provided
     the two cars are owned either by him/herself or members of his/her family residing in the same household,
     thus permitting the ticket to be used for either car at any one time, but not for both cars together. Only one
     permit will be issued. Copies must not be displayed.

3.   An application for a season ticket must be made to the Head of Community Services, Derbyshire
     Dales District Council, Town Hall, Matlock, Derbyshire, DE4 3NN, on the official application form, a copy of
     which is attached. The appropriate fee or a Direct Debit Mandate must accompany the application form.

4.   Tickets will be valid from the date of issue for a period of 6 or 12 months. Tickets will not be backdated.

5.   No guarantee can be given that a parking space will be available.

6.    A refund on season tickets will be made on application to the Head of Community Services providing that at
     least one calendar month of the season ticket’s period is still valid. To obtain a refund, the current season
     ticket MUST be surrendered for cancellation. The amount of the refund will be proportionate to the number
     of complete calendar months remaining. Payment of the refund will be by cheque.

7.   A season ticket can be renewed by submitting a new application form prior to the expiry of the current permit.
     A reminder and application form will normally be sent out no later than 4 weeks prior to the expiry date.
     Ticket holders who currently pay by direct debit need not submit a new mandate.

8.   A renewal ticket will be issued on application, but will not become valid until the expiry of the current ticket.

9.   Any loss of a season ticket must be reported to the Head of Community Services in writing as soon as


1.   A season ticket may only be used in accordance with the terms prescribed by the Derbyshire Dales (Off-
     Street Parking Places) Order 2000. A ticket, when displayed, will exempt the holder from payment of normal
     parking fees. All other conditions for parking will apply.

2.   The conditions for parking (and any other restrictions in force) are summarised on the ticket issuing
     machine(s) or accompanying tariff board(s) on the designated car park.

3.   A season ticket will permit parking only on the car park(s) designated on the ticket. It is not valid on any
     other car park.

4.   A season ticket must be displayed on the inside of the vehicle windscreen, so that its face is clearly visible
     from the outside. Failure to display a valid car parking ticket or current season ticket will render the driver of
     the vehicle liable for payment of an Excess Charge of £70.00.

5.   The Derbyshire Dales (Off-Street Parking Places) Order 2000 is available for inspection at the Town Hall,
     Matlock, during normal working hours.

                                                   Page 4 of 4

eForm 474.64955, published Nov 2005                                                                    1845649557

Shared By:
Description: Car Parking Discount Season Ticket Application Form