Affirmation General Information

Affirmation

I am a senior 65 years of age or older. I affirm under penalty of perjury that all statements made on this application, which METRO relies on to determine my eligibility status, are true and complete. I have read and understand all of the information contained in this application. I understand that all statements made in this application may be subject to investigation and verification, and that a material misstatement or fraud will disqualify me for reduced-fare privileges. I understand that METRO may discontinue or change its discount program without notice. If METRO should find that I have not followed the discount program conditions of use, I understand that my discount fare card will be cancelled and I will not be eligible to reapply for a discount. I understand that it is a crime to allow anyone other than myself to use my Discount METRO Q? Fare Card or METRO Day Pass.

General Information

Have a question or need assistance with filling out your application? Help is available by calling 713-652-8994. If you are physically unable to complete the form yourself, a friend or relative may assist you. You can also visit the METRO RideStore located at 1900 Main Street. Store hours are Monday through Friday, 8 a.m. to 5 p.m. Remember to bring your government-issued ID verifying that you are a senior (65-69) or 70+ years of age. All information provided will be used solely to determine your eligibility for the discount METRO Q? Fare Card or METRO Day Pass. All METRO vehicles are 100% ADA accesible.

CONTACT

US

________________________________ Print Name ________________________________ Applicant's or Personal Rep. Signature ________________________________ Date

Plan your trip at .

Call 713-635-4000 for additional information.

PRINTED 09/19

ATTN: CUSTOMER SERVICE - FARE

SENIORITY

HAS ITS

BENEFITS

ENJOY HALF-PRICE

RIDES!

Discount fare for seniors (ages 65+) and Medicare cardholders

Get Ready to Ride

METRO discount fare cards help seniors (ages 65-69) and Medicare cardholders ride all METRO bus and METRORail services at a reduced rate of 50% off the regular fare! Whether your day is filled with business or pleasure, METRO senior discounts save you money every time you get on board.

Longevity Has Its Privileges

METRO offers seniors two exclusive discounts:

1. Seniors (ages 65-69) and Medicare Cardholders ? Receive 50% off all METRO fares

2. Seniors 70+ ? Ride METRO FREE for life

A Tale of Two Cards

Not sure which discount fare card you should use? Compare the two and see which works best for your style of travel.

Senior Discount Card Features

METRO

Q? Fare Card

METRO

Day Pass

50% discount on all bus and METRORail service for seniors (65-69)

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Card is reloadable and can be used to add money when the balance is low.

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Best value for riders who use local bus, commuter bus or METRORail only once or twice daily

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Best value for frequent local bus and METRORail riders who travel three or more times daily

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Offers 5 FREE rides for every 50 paid rides.

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Offers unlimited local bus and METRORail service with just three paid taps of your card.

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Seniors (65-69) never pay more than $1.50 a day to ride unlimited local bus and METRORail service.

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FREE transfers valid for three hours of travel in any direction

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Registered cardholders can transfer money from a lost or stolen card to another.

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How Do I Pay?

METRO currently offers three ways to pay your fare: ? METRO Q? Fare Card ? METRO Day Pass ? Cash While cash will always be accepted on our buses and trains, the senior discount and other benefits are only available to qualified METRO Q? Fare Card and METRO Day Pass cardholders.

How Do I Get My Card?

Seniors (ages 65-69) and those 70+ can complete the application and apply in person at the METRO RideStore located at 1900 Main Street (weekdays 8 a.m. to 5 p.m.), or mail the form back to us with a photocopy of one of the following government-issued IDs:

? Driver's License ? Passport ? Medicare Card ? Valid State ID ? Any Government-issued ID Seniors can also submit paperwork and purchase their discount fare card via METRO's online RideStore. Download the application under the Fares tab and learn more at or call 713-635-4000.

ALL INFORMATION IS KEPT

STRICTLY CONFIDENTIAL.

Discount Fare Card Type

New Applicant Card Type q METRO Q? Fare Card q METRO Day Pass

New Applicant Age Eligibility q Senior 65-69 q Senior 70+

q Renewal METRO Q? Fare Card or Day Pass Serial Number:

Customer Information: (print in ink and sign where indicated)

______________________________ Last Name

______________________________ First Name

______________________________

Street

Apt.

______________________________

City

State

Zip Code

( _____ )_______________________ Telephone number _______________________________ Email

Date of Birth: (Required for card registration.)

Month

Day

Year

q Male

q Female

Please attach proof of age documentation. A photocopy of one of the following government-issued IDs is required:

q_ Driver's License q Medicare Card

q_ Passport

q Valid State ID

q Other Government-issued ID

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