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COMPANY INFORMATION: to be processed. Please fill out completely for your order
Please fill out completely. Your order  
Company Name   Date      *
Contact Name/Title    *   
Address (We do not deliver to P.O. Boxes or Box Zip Codes)   Suite/Floor/Room    * *
City   Zip   State * * *
Phone   Fax       *
Email (Important: To receive order and shipping confirmation)         *
SHIPPING ADDRESS IF DIFFERENT:    
   Company Name       
Address (We do not deliver to P.O. Boxes or Box Zip Codes)   Suite/Floor/Room   
City   Zip   State
SEND FORM & PAYMENT TO:    
Standard Deliveries:   Overnight & Messenger* Deliveries:      JPMorgan Chase
* Note: Messenger Center is located on Willoughby Street entrance. TransitCenter, Inc. General Post Office PO Box 27457 New York, NY 10087-7457 Attn: Lockbox 27457 4 Chase Metro Tech Ctr, 7th Fl. East Brooklyn, NY 11245 1.800.945.CHEK (2435)
ORDER INFORMATION       TransitChek is an IRS-approved commuter benefits program that lets employees save money on their commute by transit or eligible vanpools with tax-free dollars. They are eligible to use up to $230/month, tax-free. Please visit our website at: www.transitcenter.com for more information on using the TransitChek Program and other helpful information.
1. How to Order             Order Frequency: How frequently do you plan to order:      2. Payment Options   3. Shipments All products will be received 7-10 business days after receipt of payment.     They will arrive in one box, via FedEx 2 Day service, and     Determine how many products you need to order per employee per benefit cycle. There is no minimum order.      Orders will not be processed until full payment is received. Please make checks payable to   "TransitCenter, Inc."   You may use a Certified Check, Bank Check, Money Order or Bank Transfer when placing your order. Sorry, no credit card orders at this time.       require a signature for delivery. 4. Fees Packaging and delivery fees for TransitChek orders are $18. Processing fees are 4.5% of your total order.
For questions about your order or assistance with ordering, call TransitCenter Customer Service at: 1.800.945.CHEK (2435).         Or visit us at www.transitcenter.com
PRODUCT SELECTION CHART      
MetroCard ®            TransitChek ®
Pay-Per-Ride Cards (includes 15% bonus)         Denominations Quantity $23.48 (12 trips)   $ $23.48 = Cost/ Item Total Cost x                                                   
             $30   $ $30 =    x                                                  
TransitChek    Card, a prepaid Visa ® ®                    (Not Returnable/ Not Refundable)                                card
FREE           (Limit one per employee) TransitChek Card User's Guides. Quantity:
TransitChek® Voucher           Not accepted at MTA NYC Transit subway station booths            (Not Returnable/ Not Refundable)
         Denominations Quantity $15   $ $15 = Cost/ Item Total Cost x                                    
         Total (   $ )    +                                                  +            
   The TransitChek® Prepaid Visa® Card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC. © 2010 TransitCenter, Inc. All Rights Reserved OF-0210
                  $29.35 (15 trips) $ $29.35 = x                                    
                       $39.13 (20 trips) $ $39.13 = x                                    
                          Unlimited Ride Cards   7-Day Unlimited $ $27 = x                           
                                            7-Day Express Bus Plus   $ $45 = x             
                                                           30-Day Unlimited $ $89 = x   
                                                                    $ TransitChek MetroCard Total
         Denominations Quantity Cost/ Item Total Cost
                    $35 $ $35 = x                                                    
                                 $45 $ $45 = x                                        
                                           $50 $ $50 = x                                 
                                                  $55   $ $55 = x                            
                                                                                      $60 $ $60 = x                       
                                                                   $65 $ $65 = x                           
                                                                            $70 $ $70 = x           
                                                                                   $89 $ $89 = x      
                                                                           $ TransitChek Card Total                                       
                  $30 $ $30 = x                                              
                              $35 $ $35 = x                                
                                        $45 $ $45 = x                   
                                                                                                         $ TransitChek Voucher Total
                   4.5% Processing Fee ( $ .045 ) x                                                 
                           $18.00 Packaging and Delivery                                       
                                               Total Order Cost ( $ )                                    + +  
              
            New York Metro    
Order Form
PRINT HERE TO ENSURE PROPER FORMATTING >>
Phone   Fax      
Email (Important: To receive order and shipping confirmation)        
                                                                                   $110 $ $110 = x      
                                                                                   $125 $ $125 = x      
                                                                                   $150 $ $150 = x      
                                                                                   $175 $ $175 = x      
                                                                                   $200 $ $200 = x      
                                        $50 $ $50 = x                   
                                        $55 $ $55 = x                   
                                        $75 $ $75 = x                   
Order Instructions
(for your records)
Contact Name/Title          
* * Required fields
                                      $45.00 (23 trips) $ $45.00 = x            
                                        $100 $ $100 = x                   
PRODUCT RETURN POLICY    
TransitChek MetroCard:                     Returns should not be sent to the addresses listed above!   TransitChek® Vouchers: Can not be returned for credit or refund.           TransitChek only allows for unused, unopened TransitChek® Pay-Per-Ride MetroCard® and TransitChek® Unlimited Ride MetroCard® products that are not more than two years past the expiration date to be returned. Damaged MetroCard must be mailed to MTA-NYC Transit for replacement.      Please send wrapped MetroCard products to:   TransitCenter, Inc.,   http://www.transitcenter.com/order. For questions about returning wrapped MetroCard products, call TransitCenter Customer Service at 1.800.945.CHEK (2435).             TransitChek® Card, a prepaid Visa® card: Cards have a one year expiration. Balances on TransitChek Cards that Pre-addressed postage-paid envelopes with questionnaires (for returns to the MTA-NYC) can be obtained at subway station booths. 1065 Avenue of the Americas, 16th Flr., New York, NY 10018 along with a completed TransitChek Return Authorization Form found at: Can not be returned for credit or refund. are near expiration or you suspect are damaged can be easily transferred to another TransitChek Card at www.transitcenter.com under Manage Your Account. Please remind your employees to review their current and unused products to make certain they are used before the expiration date.
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                                                                                   $230 $ $230 = x