HomeMy WebLinkAboutVVS Valet Service FormValley Vista Services, Inc.
17445 E. Railroad Street
City of Industry, CA 91748
Office: (626) 855-5501
Fax: (626) 581-3297
Email: vvsdiscount@myvvs.com
To be eligible for complimentary valet service, the applicant must be the account holder and have
a legally or medically recognized disability.
Please provide the following information as it appears on your trash bill.
I have attached a copy of my DMV certificate, certifying my disability.
OR
I have attached a copy of a Doctor’s note certifying my disability.
Please print clearly.
Name:
Address: City: State: Zip Code:
Phone #: Email:
Placard Number: Date Issued:
Driver’s License Number: DOB (mm/dd/yy):
X __________________________________________ Date: ________________
Applicant Signature
For Office Use Only
Account #: __________________________
Application: Approved Denied
Processed By: __________________________ Date: __________________________
CITY OF DIAMOND BAR
VALET/ROLL-OUT SERVICE
APPLICATION
Residents with A Physical Hardship