Chicago Taxi Access Program (TAP) …

                   Chicago Taxi Access Program (TAP)
                      Voucher By Mail Order Form
NOTE: FOR USE ONLY BY RTA CERTIFIED PARATRANSIT CUSTOMERS

RTA ADA Paratransit

ID Number: P _ _ _ _ _    Expiration Date: _____________________

Last Name: _________________________First Name: ___________________________

Address: ________________________________________________________________

City:________________________ State:______________ Zip Code:________________

Telephone(s):_____________________________________________________________

E-mail (optional): __________________________________________________________

Vouchers are $5.00 each. You may purchase up to thirty (30) vouchers per week.

CASH & PERSONAL CHECKS ARE NOT ACCEPTED ON MAIL ORDERS

Quantity           TOTAL               Payment Method (check one)

______ x $5.00 = $_______                     Money Order *

                                              CertifiedCheck*

                                      Credit Card +
________________________________________________________________________

*MoneyOrdersandCertifiedChecksshouldbemadepayableto:

                                         Pace

      (PrintyourParatransitIDnumberonmoneyordersandcertifiedchecks)

+     For credit card payment, please complete the following:

Credit Card                            Credit Card No.:___________________________
(check one)
                                       Expiration Date:___________________________

      Mastercard                       Cardholder's Name:________________________

      Visa                             Cardholder's
                                       Signature:_______________________________

                                (Over, please)
I understand that the TAP vouchers will be mailed to the address shown on the opposite
side within seven (7) business days of receipt of this order. I also understand that I must
present a valid RTA ADA Paratransit ID card with an ID number starting with a "P" or a
letter of eligibility from RTA with a Photo ID, along with a voucher each time I ride, and I will
only use one voucher per trip.

There are no refunds or replacements of TAP vouchers. TAP vouchers are not transfer-
able to other customers.

Signature_______________________________________Date:_____________________


Voucher By Mail Checklist

Did you:             Specify how many vouchers you are purchasing?

                     Sign and date your order form?

                     EncloseamoneyorderorcertifiedcheckpayabletoPace?

                     Include your RTA ADA Paratransit ID Permit number on your money
                     orderorcertifiedcheck?

                     Ifpayingwithacreditcard,filloutallcreditcardinformation


Questions may be directed to Pace's Paratransit Operations Department at:
                  Voice: (800) 606-1282 TTY (888) 847-0093

Send this with your form of payment to:

                                           Pace
                                TAP Voucher by Mail Program
                                     P.O. Box 806347
                                  Chicago, IL 60680-4124


OFFICE USE ONLY

Order processed by:_____________________________________ Date:______________

Starting voucher No.______________________ Ending voucher No._________________

Client Paratransit ID could not be found. Date Order Returned:______________________



                                                                                              3353 (12-06)