Eastern Shores - Smartpass Application

Eastern Shores District

Smart Pass Application
Smartpass Applicant (select one)

Initial ApplicationDuplicate
Eligibility Requirements

One (1) application is required for each registered vehicle owner (up to 5 registered vehicles per application). Each resident applicant will be required to upload a current Driver's License AND current Vehicle Registration for each vehicle listed. Both the Driver's License and Vehicle Registration must reflect the resident's Eastern Shores district address. (mortgage/lease docs, utility bills may be accepted as additional proof of residence)

Residents who lease a vehicle or use a company car must present in addition to the Driver's License and Vehicle Registration, the vehicle lease agreement and a letter on company letterhead linking the vehicle to the district property owner or full-time resident of the district.
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Smartpass Applicant (select one)*

Property OwnerRenter
Email*
example@example.com
Phone Number*

Area CodePhone Number
Driver's License Number*
Ex: S123-456-65-789-0

Please indicate

	Make	Model	Year	Color	TAG Number	Vehicle Identification Number (VIN)	Smart Pass Number (Staff Only)
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Vehicle 5

Indicate uploaded documents (Select all that apply)*

Driver's LicenseVehicle RegistrationMortgage / Lease AgreementUtility BillOther Supporting Documents
Upload documents here

Cancelof
Additional or Replacement Smart Passes

Each property will be issued up to five (5) initial Smart Passes. Additional Smart Passes may be issued at a cost of $50 each pass. In the event the initial Smart Pass must be replaced (damage, lost or stolen), a new application must be completed accompanied with a $50 replacement fee. Renters pay for each pass.
Consent & Authorization
Date Signed*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Eastern Shores District