Carlyle Towers Condominium SmarTrip Card Benefits Enrollment Form

of Registration Number Resident Information: (Please print clearly.) Resident Name:

New

Enrollment

Change

Cancel

Participation Beginning ____________

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Phone #: _______________ and/or email address: _________________________________ Building & Unit #: ___________________________________________

Registration for SmarTrip Card or Senior SmarTrip Card: Transit Only Serial Number: _______________________________ Monthly SmarTrip Card Amount (provided by CCC, effective the 1st of the month): $20.00 I authorize the CTC to register this SmarTrip Card as part of its Residential Account. Every month, $20 in transit value will be added to this registered card. If I do not use the entire $20 in that month, the remaining balance will be credited back to CTC and will not rollover to the following month. A new $20 benefit will be added for each subsequent month I am enrolled in the program. One card per CTC Unit is eligible to be registered in this program. This agreement will remain in effect for one year through January 31, 2014. I will need to renew by January 15, 2014 to ensure uninterrupted service starting in February 2014. If I move from CTC or elect to no longer participate in this program, I must notify CTC management to cancel my participation. I understand I can add value on my own to this registered SmarTrip card. I further understand that this form must be signed and submitted by the 15 th of the prior month in order to be eligible to participate starting the first of the following month. Signature: _________________________________ Date: ________________

For CTC Office Staff Use Only: Date Received: ________________ Month to start program: _____________

Get Smart: Register for the CTC SmarTrip Card The Carlyle Council will give you $20 of SmarTrip Card value each month