Requesting Individuals Information

Airport ID Badge Holder Name*
"NA" if you have T-Hanger#
Date

Vehicle Information 1

State of Issuance*
Fueling Requested?
Select yes if you are requesting fueling authorization for Airport Authority fuel pumps.

Vehicle Information 2

State of Issuance*
Fueling Requested? - Copy
Select yes if you are requesting fueling authorization for Airport Authority fuel pumps.

Vehicle Information 3

State of Issuance*
Fueling Requested? - Copy - Copy
Select yes if you are requesting fueling authorization for Airport Authority fuel pumps.

Vehicle Information 4

State of Issuance*
Fueling Requested? - Copy - Copy - Copy
Select yes if you are requesting fueling authorization for Airport Authority fuel pumps.

Des Moines Airport Authority Vehicle Security Hangtag Procedures

Please acknowledge each point as it will reflect your full understanding and comprehension of DSM's Airport Security Rules and Regulations that are governed by the Department of Homeland Security.  You further acknowledge and agree to uphold the below listed criteria to maintain a vehicle hangtag(s). You agree and understand these below requirements and this statement set forth, as violations may terminate your privileges to operate a vehicle or maintain a DSM Security ID Badge.

Acknowledgement of Certificate of Liability Insurance showing 1 million dollars of coverage*
Provide a current copy of Certificate of Liability Insurance showing 1 million dollars of coverage (Copy can be provided at the time of picking up tag)
No File Chosen
File uploads may not work on some mobile devices.
Vehicle hangtag(s) will only be issued to active badge holders that have been assigned the Non-Movement Area privilege*
Vehicle hangtags are nontransferable between vehicles*
When picking up your vehicle hangtag you must bring your current Airport Badge *
You may only pick up the vehicle hangtag(s) that are assigned to you*
The issued vehicle hangtag must match information on file *

To be completed by the Des Moines Airport Authority

Badge Holder to complete when picking up hangtags

Use your mouse or finger to draw your signature above