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
y
an
y
person other than to whom it is issued, PEOPLE
Yea
MOVER will confiscate and destro
y
the card. If a card has been confiscated due to usa
g
e b
y
an
y
unauthorized part
y
, with the card
holder's knowled
g
e, PEOPLE MOVER has the ri
g
ht not to issue a replacement card. No exchan
g
es or refunds.
2.
)
PROPERTY OF PEOPLE MOVER: All Smartcard ID cards are the propert
y
of PEOPLE MOVER, and must be presented upon
use each time
y
ou board a PEOPLE MOVER bus. This card must be surrendered upon request b
y
a PEOPLE MOVER official.
3.
)
LOST OR STOLEN CARDS: A replacement fee will be char
g
ed for each lost or stolen card. PEOPLE MOVER reserves the ri
g
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
j
ect to confiscation, replacement fee and limits could appl
y
. It is
y
our responsibilit
y
to maintain
the Smartcard ID in a
g
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
g
e media of a di
g
ital bus pass, but does not b
y
default come loaded with a pass. You still must purchase ride or da
y
passes at
y
our eli
g
ible rate to use the Smartcard as a pass.
I understand that the information collected on this form is for the purpose of determinin
g
eli
g
ibilit
y
for the PEOPLE MOVER Half Fare
Pro
g
ram and all information provided will be kept confidential. PEOPLE MOVER maintains the ri
g
ht to verif
y
m
y
eli
g
ibilit
y
at an
y
time.
I affirm that all information
g
iven is true and complete. If at an
y
time m
y
condition of eli
g
ibilit
y
chan
g
es I will notif
y
PEOPLE MOVER and
I understand m
y
eli
g
ibilit
y
can cease until I requalif
y
. I understand that fraud or abuse will result in confiscation of the Smartcard ID and
termination of m
y
eli
g
ibilit
y
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
Rideline3436543 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