Submit completed form and all supporting documents to SmartPass@vta.org.Smartpass Agreement • January 15th, 2021 • California
Institution Name (Provide DBA or prior institution name, if applicable) Billing Address (Street, City, State, ZIP Code) Federal Tax Identification Number (If your organization has federal tax‐exempt status, provide your tax ID number and any supporting documents. For more information on acceptable documents, visit www.irs.gov/charities‐non‐profits/exempt‐organizations‐affirmation‐letters). Coordinator Contact Information (Name, Title, Email, Phone) Primary Coordinator: Back‐up Coordinator: Miscellaneous Do you require a Purchase Order to process payments? □ Yes □ No FOR VTA USE ONLY May VTA identify your Institution as a member of the SmartPass Program in promotional material? □ Yes □ No SmartPass Category: Is your Institution required by a local city ordinance to enroll in a transit program such as the SmartPass Program? □ Yes □ No Location Address Headcount per Location† Service Level Annual Rate per Person Amount a. b. c. Agreement Period Quantity
