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COMPANY INFORMATION: cannot be processed unless all information is provided. Please fill out completely. 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:    
Name   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    
1. How to Order             2. Reorders How frequently do you plan to order:      3. Payment Options   4. Shipments All products will be received 7-10 business days after receipt of payment.   Please note: TransitChek Cards will be shipped separately from TransitChek MetroCards and/or TransitChek Vouchers. "TransitCenter, Inc." Determine how many products you need to order per employee per benefit cycle. There is no minimum order. TransitChek®Card, a prepaid Visa® card is nonreturnable and nonrefundable. Orders will not be processed until full payment is received. Please make checks payable to 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.
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
TRANSITCHEK PRODUCTS    
MetroCard ®        TransitChek ®
Pay-Per-Ride Cards (includes 15% bonus)         Denominations Quantity $24.35 (14 trips)   $ $24.35 = 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       
         Denominations Quantity $15   $ $15 = Cost/ Item Total Cost x                                    
         Total (   $ )    +                                                  +            
   The TransitChek® Prepaid Visa® Card is issued by The Bankcorp Bank pursuant to a license from Visa U.S.A. Inc. The Bankcorp Bank; Member FDIC. © 2008 TransitCenter, Inc. All Rights Reserved OTCOF-1108
                  $31.30 (18 trips) $ $31.30 = x                                    
                       $40.00 (23 trips) $ $40.00 = x                                    
                          Unlimited Ride Cards   7-Day Unlimited $ $25 = x                           
                                            7-Day Express Bus Plus   $ $41 = x             
                                      14-Day Unlimited $ $47 = x            
                                                           30-Day Unlimited $ $81 = x   
                                                                    $ TransitChek MetroCard Total
         Denominations Quantity Cost/ Item Total Cost
                    $35 $ $35 = x                                                    
                                 $45 $ $45 = x                                        
                                           $50 $ $50 = x                                 
                                                  $60   $ $60 = x                            
                                                                                      $65 $ $65 = x                       
                                                                   $81 $ $81 = x                           
                                                                            $115 $ $115 = x           
                                                                                   $120 $ $120 = x      
                                                                           $ TransitChek Card Total                                       
                  $30 $ $30 = x                                              
                              $35 $ $35 = x                                
                                        $50 $ $50 = x                   
                                                                                                         $ TransitChek Voucher Total
                   4.5% Processing Fee ( $ .045 ) x                                                 
                           $18.00 Packaging and Delivery                                       
                                               Total Order Cost ( $ )                                    + +
              
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