Citation Payment Agreement Request

Pursuant to California State University (CSU) policy 4071, Cal State LA is offering a payment agreement for multiple unpaid citations or citations totaling $200 or more. To initiate this agreement, 10% of the amount owed and an additional $25 enrollment fee must be paid. Subsequent payments will be made by the 20th of each month, as set by Cal State LA Parking Services. Please complete the form below to begin this process.

Last Name

Last name of person requesting agreement

First Name

First name of person requesting agreement

CIN/EIN

Campus or employee ID number is applicable

Number of Citations

The number of outstanding citations owed

Amount Owed

Estimated amount of outstanding balance owed

License Plate Number

The license plate for associated for the outstanding citations

Is there more than one vehicle that received the citations?

List other plate numbers associated with these citations

List other plate numbers associated with these citations. Please separate with a comma

Email address of person requesting Citation Agreement

Cell Phone Number

Cell phone or best phone number to reach the individual requesting a Citation Agreement

Have you previously entered into a Citation Payment Agreement with Cal State LA

YES

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