Submit completed form and all supporting documents to smartpass@ibigroup.com.Smartpass Agreement • October 4th, 2022 • 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 (Full Name, Title, Email Address, Phone Number) Primary Coordinator: Back-up Coordinator: Miscellaneous Do you require a Purchase Order to process payments?If yes, please include the PO number here: □ Yes □ No FOR VTA USE ONLY(To be completed by VTA staff) May VTA identify you as a member of the SmartPass Program in promotional material? □ Yes □ No SmartPass Category Are you required by a local city ordinance to enroll in a transit program such as the SmartPass Program? □ Yes □ No Address of Each Participating Facility Headcount perFacility† Service Level Annua
Submit completed form and all supporting documents to smartpass@ibigroup.com.Smartpass Agreement • October 31st, 2023 • California
Institution Name (Provide DBA or prior Institution name, if applicable) Billing Address (Street, City, State, ZIP Code) Not For Profit Status: If your organization has federal tax exempt status, provide your Federal Tax ID Number below. For more information on acceptable federal documents, visit www.irs.gov/charities-non-profits/exempt-organizations-affirmation-letters. If your organization has Welfare Exemption status issued by the California State Board of Equalization (BOE), provide your Organizational Clearance Certificate (OCC) or Supplemental Clearance Certificate (SCC) number below. Coordinator Contact Information (Full Name, Title, Email Address, Phone Number) Primary Coordinator: Back-up Coordinator: Miscellaneous Do you require a Purchase Order to process payments?If yes, please include the PO number here: Yes No FOR VTA USE ONLY(To be completed by VTA staff) May VTA identify you as a member of the SmartPass Program in promotional material? Yes No SmartPass Category Are
Submit completed form and all supporting documents to smartpass@arcadis.com.Smartpass Agreement • October 4th, 2024 • California
Institution Name (Provide DBA or prior Institution name, if applicable) Billing Address (Street, City, State, ZIP Code) Not For Profit Status: If your organization has federal tax exempt status, provide your Federal Tax ID Number below. For more information on acceptable federal documents, visit www.irs.gov/charities-non-profits/exempt-organizations-affirmation-letters. If your organization has Welfare Exemption status issued by the California State Board of Equalization (BOE), provide your Organizational ClearanceCertificate (OCC) or Supplemental Clearance Certificate (SCC) number below. Coordinator Contact Information (Full Name, Title, Email Address, Phone Number) Primary Coordinator: Back-up Coordinator: Miscellaneous Do you require a Purchase Order to process payments?If yes, please include the PO number here: Yes No FOR VTA USE ONLY(To be completed by VTA staff) May VTA identify you as a member of the SmartPass Program in promotional material? Yes No SmartPass Category Are
