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Adding and/or Canceling Passes
Employer Annual Pass Program
Employer Information
__________________________________________________________________________ ____________________________________ employer/company name date
_________________________________________________________________________________________________________________street address
_________________________________________________________________________ ____________________________________ city, state, zip phone
_________________________________________________________________________ ____________________________________employer representative e-mail
Passes Added
month starting rate # of passes total
$ x = $
$5.00 TAP Card Fee (non-refundable) $ 5.00 x = $
Total Payment Due = $
Passes Canceled
month canceled # of passes
Total Pass Credits
Agreement
Pursuant to the existing A-TAP/B-TAP original Agreement, the Employer acknowledges that payment for additional A-TAP/B-TAP is due before a photo ID is produced and A-TAP/B-TAP are distributed to the Employer.
� By checking here, employer agrees to the above statement.
________________________________________________________________ _________________________________________________________signature date
Payment Information
Please check the form of payment.
Photos e-mailed to Customer Service at [email protected] must include company name in the subject line. Only JPEG format accepted.
Pass Credit Terms: Only pass credits will be applied to your account. LACMTA will not issue refunds for canceled passes.
ocredit card
Online payment instructions will be emailed to the email address on >le from [email protected]. Your order will not be processed until payment is received in full by LACMTA.
Do not provide credit card information on form.
ocheck Make checks payable to: Employer Annual Pass Program or LACMTA.
Please mail check with form to the address below.
check/money order number
amount
Submit your payment and application:
e-mail [email protected]
fax 213.922.7586
mailEmployer Annual Pass ProgramOne Gateway Plaza Mail Stop 99-PL-4Los Angeles, CA 90012
for more info
call 866.TAPTOGO
visit metro.net/annualtap
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Adding and/or Canceling Passes (continued)
Employer Annual Pass Program
Passes Added
Important: Copy of a company issued ID or copy of current pay stub that only states company and employee name must be attached for each employee added to the program.
first name last name
sample: Joe Smith
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Passes Canceled
Pass Credit Terms: Only pass credits will be applied to your account. LACMTA will not issue refunds for canceled passes. LACMTA may require proof of separation between the employee and employer.
first name last name
sample: Joe Smith
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