Request Parking Permit

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                                                <span class="breadcrumb_pill_label">Request Parking Permit</span>
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                        <h1 class="page_title" id="page_title" tabindex="-1">Request Parking Permit</h1>

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                        <form class="js-parking-permit-form generic_form" method="post" action="">
                            <label>
                                Request Type <span class="form_required_star">*</span>
                                <select class="js-parking-permit-form-request-type" name="request_type" required>
                                    <option value="daily">Daily Permit</option>
                                    <option value="monthly">New Monthly Permit</option>
                                    <option value="updatemonthly">Update Monthly Permit Information</option>
                                </select>
                            </label>

                            <h2>
                                Driver Information
                            </h2>

                            <label>
                                Employer <span class="form_required_star">*</span>
                                <select name="employer" required>
                                    <option value="university">University</option>
                                    <option value="health">Health System</option>
                                    <option value="other">Other</option>
                                </select>
                            </label>

                            <div class="js-parking-permit-form-conditional" data-condition="monthly,updatemonthly">
                                <label>
                                    Affiliation <span class="form_required_star">*</span>
                                    <select name="affiliation" required>
                                        <option value="">--Select from the following--</option>
                                        <option value="faculty">Faculty</option>
                                        <option value="staff">Staff</option>
                                        <option value="gradstudent">Graduate Student</option>
                                        <option value="odyssey">Odyssey</option>
                                        <option value="bargaining">Bargaining Unit</option>
                                        <option value="other">Other</option>
                                    </select>
                                </label>

                                <label>
                                    JHU / JHHS ID Card #
                                    <input type="text" name="jhuidcard" />
                                </label>
                            </div>

                            <label>
                                Personnel No. (PERNR)
                                <input type="text" name="pernr" />
                            </label>

                            <label>
                                First Name <span class="form_required_star">*</span>
                                <input autocomplete="given-name" type="text" name="firstname" value="" required />
                            </label>

                            <label>
                                Last Name <span class="form_required_star">*</span>
                                <input autocomplete="family-name" type="text" name="lastname" value="" required />
                            </label>

                            <div class="js-parking-permit-form-conditional" data-condition="monthly,updatemonthly">
                                <label>
                                    Address 1
                                    <input type="text" name="address1" />
                                </label>

                                <label>
                                    Address 2
                                    <input type="text" name="address2" />
                                </label>

                                <label>
                                    City
                                    <input type="text" name="city" />
                                </label>

                                <label>
                                    State
                                    <input type="text" name="state" />
                                </label>

                                <label>
                                    Zip
                                    <input type="text" name="zip" />
                                </label>
                            </div>

                            <label>
                                Primary Phone <span class="form_required_star">*</span>
                                <input autocomplete="tel" type="tel" name="phone" value="" required />
                            </label>

                            <label>
                                Email <span class="form_required_star">*</span>
                                <input autocomplete="email" type="email" name="email" value="" required />
                            </label>

                            <div class="js-parking-permit-form-conditional" data-condition="monthly,updatemonthly">
                                <h2>
                                    Vehicle 1
                                </h2>

                                <label>
                                    Make <span class="form_required_star">*</span>
                                    <input type="text" name="vehicle1make" value="" required />
                                </label>

                                <label>
                                    Model <span class="form_required_star">*</span>
                                    <input type="text" name="vehicle1model" value="" required />
                                </label>

                                <label>
                                    Vehicle Color <span class="form_required_star">*</span>
                                    <input type="text" name="vehicle1color" value="" required />
                                </label>

                                <label>
                                    Year
                                    <input type="text" name="vehicle1year" value="" />
                                </label>

                                <label>
                                    License Plate <span class="form_required_star">*</span>
                                    <input type="text" name="vehicle1license" value="" required />
                                </label>

                                <label>
                                    State <span class="form_required_star">*</span>
                                    <select name="vehicle1state" required>
                                        <option value="">-- Select from the following --</option>
                                    </select>
                                </label>

                                <h2>
                                    Vehicle 2
                                </h2>

                                <label>
                                    Make
                                    <input type="text" name="vehicle2make" value="" />
                                </label>

                                <label>
                                    Model
                                    <input type="text" name="vehicle2model" value="" />
                                </label>

                                <label>
                                    Vehicle Color
                                    <input type="text" name="vehicle2color" value="" />
                                </label>

                                <label>
                                    Year
                                    <input type="text" name="vehicle2year" value="" />
                                </label>

                                <label>
                                    License Plate
                                    <input type="text" name="vehicle2license" value="" />
                                </label>

                                <label>
                                    State
                                    <select name="vehicle2state">
                                        <option value="">-- Select from the following --</option>
                                    </select>
                                </label>
                            </div>

                            <h2 class="js-parking-permit-form-conditional" data-condition="daily,monthly">
                                Permit and Payment Details
                            </h2>

                            <div class="js-parking-permit-form-conditional" data-condition="monthly">
                                <p style="color: red">
                                    Packs of 10 or more may be purchased by payroll deduction; smaller amounts must be paid by Credit Card.
                                </p>

                                <label>
                                    Requested Payment Method <span class="form_required_star">*</span>
                                    <select name="requestedPaymentMethodMonthly" required>
                                        <option value="payrolldeduct">Payroll Deduction (1st Payment by Credit Card)</option>
                                        <option value="creditcard">Pay with credit card (one-time payment for 1 month)</option>
                                        <option value="cashcheck">Pay Monthly with cash or check</option>
                                        <option value="other">Other</option>
                                    </select>
                                </label>

                                <label>
                                    Location Requested <span class="form_required_star">*</span>
                                    <select class="js-parking-permit-form-monthly-location" name="locationMonthly" required>
                                        <option value="" data-price="0">-- Select from the following--</option>
                                        <option value="athletics108" data-price="108">Athletic Reserved (requires athletics approval) - $108.00</option>
                                        <option value="pressbuilding72" data-price="72">Charles Street South/School of Ed Lot - $72.00</option>
                                        <option value="charlesstreet72" data-price="72">Charles Street/East (requires parking office approval) - $72.00</option>
                                        <option value="easternsurfacegeneral60" data-price="60">Eastern Surface Lot (General) - $60.00</option>
                                        <option value="easternsurfacereserved86" data-price="86">Eastern Surface Lot (Reserved) - $86.00</option>
                                        <option value="educationbuilding72" data-price="72">Education Building - $72.00</option>
                                        <option value="eveningweekendhangtag25" data-price="25">Evening/Weekend Hangtag - $25.00</option>
                                        <option value="facultyhangtag115" data-price="115">Faculty Hangtag - $115.00</option>
                                        <option value="greenhousereserved165" data-price="165">Greenhouse Reserved (requires approval) - $165.00</option>
                                        <option value="homewoodaccessible72" data-price="72">Homewood Accessible Parking - $72.00</option>
                                        <option value="keswickgeneral64" data-price="64">Keswick Parking (General) - $64.00</option>
                                        <option value="mtwashingtonnorth64" data-price="64">Mt. Washington (North) - $64.00</option>
                                        <option value="mtwashingtonsouth64" data-price="64">Mt. Washington (South) - $64.00</option>
                                        <option value="northsurface72" data-price="72">North Surface Lots - $72.00</option>
                                        <option value="olinreserved110" data-price="110">Olin Reserved Lot - $110.00</option>
                                        <option value="sanmartingeneral115" data-price="115">San Martin Garage (General) - $115.00</option>
                                        <option value="sanmartinreserved165" data-price="165">San Martin Garage (Reserved) - $165.00</option>
                                        <option value="southgarage115" data-price="115">South Garage (General) - $115.00</option>
                                        <option value="southgarage165" data-price="165">South Garage (Reserved) - $165.00</option>
                                        <option value="westgatereserved165" data-price="165">West Gate Garage (Reserved) - $165.00</option>
                                    </select>
                                </label>

                                <label>
                                    Accessible Parking Needed
                                    <select name="accessibleParkingNeededMonthly">
                                        <option value="no">No</option>
                                        <option value="yes">Yes</option>
                                    </select>
                                </label>
                            </div>

                            <div class="js-parking-permit-form-conditional" data-condition="daily">
                                <p style="color: red;">
                                    Packs of 10 or more may be purchased by payroll deduction; smaller amounts must be paid by Credit Card.
                                </p>

                                <label>
                                    Requested Payment Method
                                    <select id="js-parking-permit-form-payment-method" name="requestedPaymentMethodDaily">
                                        <option value="creditcard">Credit Card</option>
                                        <option value="payrolldeduct">Payroll Deduction</option>
                                    </select>
                                </label>

                                <label>
                                    Location Requested <span class="form_required_star">*</span>
                                    <select class="js-parking-permit-form-daily-location" name="locationDaily" required>
                                        <option value="" data-price="0">-- Select from the following--</option>
                                        <option value="eastern6" data-price="6">Eastern Surface Lot - $6.00</option>
                                        <option value="education6" data-price="6">Education Building - $6.00</option>
                                        <option value="homewood8" data-price="8">Homewood Campus Garages - $8.00</option>
                                        <option value="keswick6" data-price="6">Keswick Parking - $6.00</option>
                                        <option value="washingtonnorth6" data-price="6">Mt. Washington (North) - $6.00</option>
                                        <option value="washingtonsouth6" data-price="6">Mt. Washington (South) - $6.00</option>
                                        <option value="field6" data-price="6">Homewood Field Lot (staff) - $6.00</option>
                                        <option value="hfield10" data-price="10">Homewood Field Lot (vistors) - $10.00</option>
                                    </select>
                                </label>

                                <label>
                                    Number of Daily Permits

                                    <select class="js-parking-permit-form-permits-daily" name="numberPermitsDaily" required>
                                        <option value="1">1</option>
                                        <option value="2">2</option>
                                        <option value="3">3</option>
                                        <option value="4">4</option>
                                        <option value="5">5</option>
                                        <option value="6">6</option>
                                        <option value="7">7</option>
                                        <option value="8">8</option>
                                        <option value="9">9</option>
                                        <option value="10">10</option>
                                    </select>
                                </label>
                            </div>

                            <div class="js-parking-permit-form-conditional" data-condition="daily,monthly">
                                <h3>
                                    Estimated Price
                                </h3>
                                <p class="js-parking-permit-form-price">$0.00</p>
                            </div>

                            <h2>
                                University Parking Regulations
                            </h2>

                            <p>PLEASE READ: In accepting a Johns Hopkins University parking permit, I agree to be bound by the official regulations governing travel on the University property.</p>

                            <label>
                                I Accept
                                <input type="checkbox" name="accept" value="yes" required />
                            </label>

                            <p><strong>You must select "I Accept" for your request to be processed.</strong></p>

                            <input type="submit" value="Submit Request" />
                        </form>
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