LastName
FirstName MI
Street#
StreetName Apartment
City
State ZipCode
DateofBirth
SSNlast4digits Phone#
Month
Day Year
(( ) ‐
EmailAddress
I agree to the following conditions regarding use of a PEOPLE MOVER Smartcard ID:
1.
NOT TRANSFERABLE: This card is not transferable and if presented b
an
person other than to whom it is issued, PEOPLE
MOVER will confiscate and destro
the card. If a card has been confiscated due to usa
e b
an
unauthorized part
, with the card
holder's knowled
e, PEOPLE MOVER has the ri
ht not to issue a replacement card. No exchan
es or refunds.
2.
PROPERTY OF PEOPLE MOVER: All Smartcard ID cards are the propert
of PEOPLE MOVER, and must be presented upon
use each time
ou board a PEOPLE MOVER bus. This card must be surrendered upon request b
a PEOPLE MOVER official.
3.
LOST OR STOLEN CARDS: A replacement fee will be char
ed for each lost or stolen card. PEOPLE MOVER reserves the ri
ht
to limit the number of replacement ID cards.
4.
DEFACED/DAMAGED CARDS: Cards that are cracked, have photos or other information that is faded, missin
or scratched off
will be considered invalid and sub
ect to confiscation, replacement fee and limits could appl
. It is
our responsibilit
to maintain
the Smartcard ID in a
ood and useable condition.
5.
CODE OF CONDUCT: The PEOPLE MOVER Code of Conduct must be followed at all times.
6.
BUS FARE: The Smartcard ID is not a bus pass on its own. It is a reloadable stora
e media of a di
ital bus pass, but does not b
default come loaded with a pass. You still must purchase ride or da
passes at
our eli
ible rate to use the Smartcard as a pass.
I understand that the information collected on this form is for the purpose of determinin
eli
ibilit
for the PEOPLE MOVER Half Fare
Pro
ram and all information provided will be kept confidential. PEOPLE MOVER maintains the ri
ht to verif
m
eli
ibilit
at an
time.
I affirm that all information
iven is true and complete. If at an
time m
condition of eli
ibilit
chan
es I will notif
PEOPLE MOVER and
I understand m
eli
ibilit
can cease until I requalif
. I understand that fraud or abuse will result in confiscation of the Smartcard ID and
termination of m
eli
ibilit
of use.
XDate
Eligible
Qualifying under this criteria will only be a Temporary Eligibility for 90 days for one time only.
Years
IDnumber:
Exp.Date:
Duration
Months
Rideline343‐6543 www.peoplemover.org
HalfFareProgramInstantQualifiers
To be eligible for the People Mover Half Fare Program same day instant qualification you must meet one or more of the eligibility
conditions below and have a valid form of ID with proof of eligibility condition .
Medicare Card Holder ( Medicare Card or proof of Medicare enrollment )
Transit Agency
Eligibility
( Expiration Date:________________ PCA:________ )
Youth ( Age 18 and Under )
Senior ( Age 60 and Up )
ReviewedBy:
Veteran ( DD214
with honorable discharge
, VA ID card, State ID
with Veteran Marker
)
AnchorRIDES Eligible ( Expiration Date:________________ PCA:________ )
PEOPLEMOVERHalfFareProgramApplication
Date:
Official
Use
Only
