Texas Application

Ineligible for Pre-Qualification!

Unfortunately, you do not pre-qualify for the handicapped placard at this time. If you have any questions or concerns, please feel free to reach out to us for further assistance.
Contact us: Email: support@handicappedparking.com Phone: (800) 380-9070

Alternatively, you can fill out the form on our contact page.
You Pre-Qualify!

Next are Optional Questions and Payment! After this all you need to do is schedule your doctor's consultation whenever is convenient for you and receive your placard after your eligibility is confirmed.
What is your full name?*

First NameMiddle NameLast Name
What is your date of birth?*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Would you like to add anything else to your application for the doctor to review?
Optional Questions

All the questions from this form are to complete your DMV application, the more you answer the more filled in your application will be. Alternatively, you can complete these after your doctor consultation. If you do not feel comfortable providing these details you can leave them blank and fill them out on your own after receiving your application via email.
NowLater
Note: For License Plate Applications

*We will need your vehicle information to complete the application; however, if you do not have this information, please leave it blank and complete it when you receive your application in the mail.
Passenger Car (Typical Car)Truck (Up to 18,000 lbs.)Motorcycle/Moped
Vehicle Make
Vehicle Year
Vehicle Identification Number (VIN): *Generally found on your DMV statement or the driver side bottom of the exterior windshield.
Current TX Plate
Texas-Issued Driver's License or ID # and "TX" separated by a comma (example: "12345678, TX")
The DL or ID # provided on this application will be partially shown on the placard issued.
Note: Required Information for Shipping

Texas requires physical copies of your parking placard application and a prescription document (BOTH INCLUDED). These must be mailed to you and are available for free (approximately 3-7 business days) or express (approximately 2-3 business days). Due to this, we require a physical address to mail your application; make sure there are no typos as that could delay your application.
Street Address (NO CITY OR STATE)*
City*
State*
Zip*
Identification Statement – Texas State law makes falsifying information a third-degree felony. I meet the eligibility requirements listed on this application. I am providing proof to that effect or making an application on behalf of a person with a disability.*
Standard (VTR-214)Veteran (VTR-615)
Signatory Name as printed on your Driver's License or Identification Card*
Today's Date*

MonthDayYear
Date

YesNo
Please provide their FIRST and LAST NAME so we can send them a gift! (Optional)
If you refer us to someone who qualifies we're happy to send you a gift as well!
Should be Empty:

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Enter coupon

Let's See if You Pre-Qualify in Texas!

Ineligible for Pre-Qualification!

You Pre-Qualify!

Optional Questions

Note: For License Plate Applications

Note: Required Information for Shipping