Cease Operations Request Form

This form is for the intended use of OAK Ground Transportation Tenants who wish to terminate their operation with the Oakland Airport. In the space below, please provide your company information.

The OAK transponder(s) and OAK permit(s) must be returned in order to process any applicable refund.
Cease Operations Date

MonthDayYear
Tenant Number
Ground Transportation Permit Type

Door-to-Door On-Demand Shuttle PermitDoor-to-Door Reservation Shuttle PermitHotel Courtesy Vehicle PermitLimousine PermitOff-Airport Parking Courtesy Vehicle PermitScheduled or Charter Operator Vehicle Permit
Company Name*
DBA

TCP#, PSC#, CA#, Other Authority ID#

Rows	TCP #	PSC #	CA #	Other #
Authority ID

Business Address

Street Address

Street Address Line 2

CityState

Zip Code
Contact Name

First NameLast Name
Pnone Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
Email
example@example.com
If you are requesting a refund of your security deposit, please provide a copy of your deposit check, and/or deposit receipt.

Cancelof
Owner/Company Authorized Representative Signature

Clear
Submittal Date
For Office Use Only

Supporting documentation is required for processing.
Outstanding Invoices:

YesNo
Comments:
If yes, inquire with Operator whether to deduct from deposit or pay outstanding fee upfront.
OAK Permit(s) Returned:

YesNo
Comments:
OAK Transponder(s) Returned:

YesNo
Comments:
Refund Security Deposit Amount:
Signature:

Clear
Ed Coates, Aviation Airport GT & Parking Ops Coordinator • Aviation Ground Transportation Services
Date

MonthDayYear
Date
Signature

Clear
Please note when pressing submit the account close out process begins. Next you will be forwarded to a new form to complete a W-9 form. A completed W-9 form must be on file to process any applicable refund, i.e. AdComp credit balance. If you would prefer to mail in a W-9 directly please contact our office for mailing instructions.
Should be Empty:

For Office Use Only