Access Credential Application

Airport Credential Application - Permitted Tenant

Welcome! This application should take less than 10 minutes to complete. Please have your valid driver's license and current vehicle insurance certificate available prior to starting this form.*The first credential for a Named Permitted Tenant is complimentary. Any additional credentials will be billed directly the Permit Holder at a fee of $10.00 each.
Full Name

First NameMiddle NameLast NameSuffix
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email Address

Confirmation EmailPlease verify email
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Have you previously been granted an access credential at Chicago Executive Airport?
If you have been access credentialed before, which entity were you associated with?

Aircraft and Hangar Information
Applicant Type
Permit Name
Ex. Blue Sky, LLC.
Permit/Partnership Name
Ex. N123AB, LLC.
Proof of Aircraft Partnership

If an aircraft partner, please upload a document that proves your partnership/interest in the aircraft. This can be some legal document listing the partnership, insurance document naming you as a partner, LLC agreement, etc. This will be reviewing by Airport Operations
Cancelof
List your Aircraft
What area will your Aircraft be located?
Finance Email
example@example.com
Economic Developement
example@example.com
Northeast T Hangar #
Northeast T Hangar 52 Bay
Northeast T Hangar 53 Bay
Northeast T Hangar 54 Bay
Northeast T Hangar 55 Bay
Northeast T Hangar 56 Bay
Northeast T Hangar 57 Bay
Northeast Tie-Down Spot#
Southwest T Hangar#
Southwest T Hangar 50 Bay#
Southwest T Hangar 51 Bay#

Vehicle and Insurance Information
List ALL of your vehicle(s) that may be parked within the Airport property
Please upload copy of you current/unexpired vehicle insurance certificate

Valid vehicle insurance is a required to park within the airport perimeter per the Rules & Regulations of Chicago Executive Airport.
Cancelof

Safety Video & Acknowledgements

Please watch the required YouTube video, review the campaign flyer, and carefully read the gate access safety procedures below. These materials outline the required gate access protocols at Chicago Executive Airport. If you have any questions, please contact Airport Operations at Ops@chiexec.com
I certify that I have watched and understand the above video PWK - Safety Starts At The Gate: Understanding The Consequences Of Non-Compliance in its entirety
Initial if you accept/agree
I certify that I have read and understand the DON'T BE MIDWEST NICE AT THE GATE campaign flier in its entirety
Initial if you accept/agree
I understand that Chicago Executive Airport access credentials must be kept in my personal possession for the safety of the Airport. I acknowledge full responsibility for damages that may result from the improper use of the access credentials. I also may not loan my access credentials to any other person or knowingly permit the use there of by another.
Initial if you accept/agree
I understand that Aircraft always have the right of way over personnel and vehicles. I will use caution around aircraft as the engines may be started at any time.
Initial if you accept/agree
I understand that failure to not wait for a gate to close whether entering or exiting the Airport may result in fines, revocation of access privileges', and/or revocation of any movement area privileges (if applicable) without notice or warning.
Initial if you accept/agree
I understand that when opening an access controlled gate while not in a vehicle, such as when walking to an access reader, to allow an individual with whom I am directly associated to gain access to the airport grounds, I must remain in the immediate vicinity of the gate until it has fully closed and secured. During this time, I am responsible for monitoring the gate area and advising any unauthorized individual seeking entry that they are not permitted to enter through the gate and must obtain authorized access by properly badging in or following established airport access procedures. I understand that allowing unauthorized access, failing to ensure the gate is fully secured, or otherwise violating access control procedures may result in fines, suspension or revocation of access privileges, and/or suspension or revocation of movement area driving privileges, where applicable, without prior notice.
Initial if you accept/agree
I understand that allowing anyone to tailgate or piggyback me through the gate may result in fines, loss of access privileges, and/or revocation of movement area privileges (if applicable), without prior notice or warning.
Initial if you accept/agree
I agree to comply with the Chicago Executive Airport Rules & Regulations in which can be found at https://www.chiexec.com/documents/.
Initial if you accept/agree
I understand that I am responsible for immediately notifying Chicago Executive Airport Operations to ops@chiexec.com when the access credential is no longer required and/or will no longer be used.
Initial if you accept/agree
I understand that my access credential is valid for two (2) calendar years and may be subject to renewal fees. I also am responsible for application of renewal.
Initial if you accept/agree
I understand that Chicago Executive Airport may tow, remove, or cause to be removed from the Airport if my vehicle is disabled, abandoned, creates a safety risk, and/or parked in violation of the Rules and Regulations at the vehicle operator’s risk and expense and without liability for damage that may result from such removal.
Initial if you accept/agree
I understand that my vehicles shall not be parked or stopped in such a manner to obstruct an Airport access gate, taxiway, taxilane, and/or obstruct access to hangars, parked aircraft, and/or parked vehicles. Vehicles must be parking in designated parking areas per the access control map.
Initial if you accept/agree
I understand that these access credentials is not an authorization to operate a vehicle on the Aircraft Movement Area. I understand that if I am to operate a vehicle on the Aircraft Movement Area requires training, testing, and certification administered by PWK Airport Operations.
Initial if you accept/agree
I understand that Chicago Executive Airport reserves the right to deny my application and and/or revoke my access credentials at any time.
Initial if you accept/agree
Access Control Map Review
Please read and review the below document in its entirety.

Verification
Upload Valid Driver's License (Front Side Only)

Cancelof
Credential Type
What form of access credential would you like (select only one)?
Airport ID Photo
ID Photos that are unclear, too dark, or do not conform to the above requirements may result in your application being denied.
For your Airport issued RFID capable ID card, we will need a full-face photo. *Please note: A clear unobstructed photo from the shoulders up, no hats, no sunglasses, enhanced AI Photos are not allowed. Please take with a neutral background and please ensure the room is well lit while taking the photo. *Access applications may be denied if the pictures is not satisfactory.
Signature
Signature to acknowledge this application, the safety rules regarding gate access procedures, and the Rules & Regulations of Chicago Executive Airport
Print Full Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please verify that you are human
Should be Empty:

Airport Credential Application - Permitted Tenant

Aircraft and Hangar Information

Vehicle and Insurance Information

Safety Video & Acknowledgements

Access Control Map Review

Verification

Credential Type

Airport ID Photo

Signature