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  7 www.EZPassNJ.com  1-888-AUTO-TOLL (1-888-288-6865) TDD/TTY 1-866-205-4000 Choose to keep your company moving...  You’re on Your Way! Business Application Enclosed. Toll Facilities Accepting E-ZPass New Jersey Turnpike Authority www.state.nj.us/turnpikeNew Jersey TurnpikeGarden State ParkwayThe New Jersey Turnpike Authority offers aPost-Paid Plan exclusively to businesscustomers. Discounts are based on toll usageduring off peak hours. To obtain an applicationor to inquire about the plan call the New JerseyE-ZPass Customer Service Center at1-888-AUTO-TOLL (1-888-288-6865). South Jersey Transportation Authority www.sjta.com Atlantic City Expressway Delaware River Port Authority www.drpa.orgCommodore Barry BridgeWalt Whitman BridgeBen Franklin BridgeBetsy Ross Bridge Burlington County Bridge Commission www.bcbridges.orgTacony-Palmyra BridgeBurlington-Bristol Bridge Delaware River and Bay Authority www.drba.netDelaware Memorial Bridge Port Authority of New York & New Jersey www.panynj.govBayonne Bridge ã George Washington BridgeGoethals Bridge ã Holland TunnelLincoln Tunnel ã Outerbridge Crossing MTA Bridges and Tunnels www.mta.info/bandtBronx-Whitestone BridgeBrooklyn-Battery TunnelCross Bay BridgeHenry Hudson BridgeMarine Parkway-Gil Hodges BridgeQueens Midtown TunnelThrogs Neck BridgeTriborough Bridge Verrazano-Narrows Bridge New York State Thruway Authority www.thruway.state.ny.usEntire New York State Thruway including:New Rochelle Barrier Yonkers BarrierTappan Zee BridgeSpring Valley (business vehicles only)Harriman BarrierBuffalo City Line BarrierBlack Rock BarrierGrand Island Bridges Peace Bridge, New York  www.peacebridge.comPeace Bridge New York State Bridge Authority www.nysba.state.ny.usBear Mountain BridgeNewburgh-Beacon BridgeMid-Hudson BridgeKingston-Rhinecliff BridgeRip Van Winkle Bridge Delaware Department of Transportation www.deldot.govInterstate 95State Route 1 Delaware River Joint Toll Bridge Commission www.drjtbc.orgTrenton-Morrisville BridgeNew Hope-Lambertville BridgeInterstate 78 BridgeEaston-Phillipsburg BridgePortland-Columbia BridgeDelaware Water Gap BridgeInterstate 80 BridgeMilford-Montague Bridge Pennsylvania Turnpike Commission www.paturnpike.comPennsylvania Turnpike Maryland Transportation Authority www.mdta.state.md.usBaltimore Harbor TunnelFort McHenry TunnelFrancis Scott Key BridgeHatem BridgeKennedy Memorial HighwayLane Memorial BridgeNice Memorial Bridge Massachusetts Department of Transportation www.massdot.state.ma.usMassachusetts Turnpike · Tobin Bridge Maine Turnpike Authority www.ezpassmaineturnpike.comMaine Turnpike New Hampshire DOT www.ezpassnh.comNew Hampshire Turnpike West Virginia Parkway Authority www.wvturnpike.comWest Virginia Turnpike Illinois State Toll Highway Authority www.illinoistollway.comNorth-South TollwayTri-State TollwayRonald Reagan Memorial TollwayNorthwest Tollway Skyway Concession Company LLC www.chicagoskyway.orgChicagoSKYWAY Indiana Toll Road Concession Company www.getizoom.com Virginia Department of Transportation www.virginiadot.org Chesapeake Bay Bridge-TunnelChesapeake ExpresswayDulles GreenwayDulles Toll RoadGeorge P. Coleman BridgePocahontas ParkwayPowhite Parkway ExtensionRMA Expressway System Rhode Island Turnpike and Bridge Authority www.ritba.orgPell Bridge Newport Ohio Turnpike Commission www.ohioturnpike.orgOhio Turnpike These Terms and Conditions, together with your application, constitute your New Jersey  E-ZPass   Agreement (the“Agreement”). A copy of these Terms and Conditions will be mailed to you along with your tag(s). Please readthese terms and conditions and keep them for your records. When you open your Account and use your NewJersey  E-ZPass   tag(s), you agree as follows: ➊  GENERAL a) Your failure to comply with this Agreement may result in suspension, revocation, or termination of yourNew Jersey  E-ZPass   account (“Account”).b) You may not assign the obligations or benefits of this Agreement.c) Your failure to pay charges posted to your Account, including tolls, may result in additional penalties asprovided by law, and may result in the suspension, revocation or termination of your Account.d) You will comply with all applicable traffic laws, regulations, signs and signals, and the direction of tollcollectors and law enforcement officers. You acknowledge that failure to do so may result insuspension, revocation, or termination of your Account.e) You will approach and pass through an  E-ZPass   lane at the posted speed and obey all traffic signs. Youacknowledge that failure to adhere to these requirements may result in the suspension, revocation ortermination of your Account. ➋  TAG USE a) Use of your New Jersey  E-ZPass   tag(s) binds you to the Terms and Conditions of this Agreement.b) Your New Jersey  E-ZPass   tag(s) may be used on the vehicle(s) specifically listed on this Account,provided that the tag type matches the class of vehicle in which it is used. Your New Jersey  E-ZPass  tag(s) is(are) accepted wherever you see the  E-ZPass   logo.c) The New Jersey  E-ZPass   tag(s) remain(s) at all times the property of New Jersey  E-ZPass   unless youpurchased the tag(s).d) You agree to surrender all your leased New Jersey  E-ZPass   tag(s) and to cease use of your purchasedNew Jersey  E-ZPass   tag(s) immediately upon request.e) When you use your tag(s) at any facilities accepting  E-ZPass  ,you authorize New Jersey  E-ZPass   to debityour Account for any and all charges incurred at those facilities, which charges are non-refundable.f) If you use your tag(s) at facilities accepting  E-ZPass   outside of New Jersey, you are subject to the lawsand regulations governing such use at those facilities.g) You agree not to use any lane accepting  E-ZPass   if your Account has an insufficient balance.You mustpay with cash in a cash lane, otherwise you may be treated as a violator. ➌  ACCOUNT INFORMATION  Your E-ZPass Account may consist of the purchase of tag(s) and a pre-paid balance as:a) Tag Purchase: Business customers are required to purchase tag(s).b) Prepaid Balance: You must maintain a prepaid balance amount with New Jersey  E-ZPass   to coverapplicable charges to your Account. Each time you use your New Jersey  E-ZPass   tag, applicablecharges will be deducted from your Account. New Jersey  E-ZPass   will also deduct applicableadministrative fees incurred under this Agreement. If your Account balance has remained negative for60 days, you will be sent a revocation warning letter notifying you to replenish your Account. If you failto replenish and maintain the minimum prepaid balance within 10 business days after a letter is sentto you, your Account will be revoked. You will not be allowed to open another Account with New Jersey E-ZPass  , and your Account will be placed with a collection agency to pursue your outstanding balance.New Jersey  E-ZPass   also reserves the right to notify any and all consumer reporting agencies of anyoutstanding balances that have been delinquent for more than 90 days.c) Account Balances:No interest will be paid on balances in yourAccount or on your refundable tag deposit.d) Replenishment: Periodically, your toll use will be reviewed. If your monthly activity is above or belowyour current monthly payment, your minimum monthly debit/credit card, cash or check payment willbe adjusted accordingly and you will be notified on your next scheduled statement.e) Automatic Credit Card Update: New Jersey  E-ZPass  , in its discretion, may receive updated informationabout your credit card, including new account numbers and expiration dates, from the financialinstitution issuing the card. However,it is your responsibility to ensure that all yourAccount informationremains up to date. ➍  ACCOUNT STATUS a) You will receive monthly Account statements, unless there were no toll revenue transactions and nofinancial activity in the Account during the applicable period.b) If you have a touch-tone phone, you may call 1-888-AUTO-TOLL (1-888-288-6865) 24 hours a day foryour Account balance. You may also access this information on the New Jersey  E-ZPass   website(www.EZPassNJ.com). You must use your PIN to access this information. ➎  PAYMENTS Method of Payment. Account replenishment must occur when your prepaid balance decreases to or belowthe threshold amount specific to the method of payment you selected. You can replenish your Account inone of the following ways:a) By selecting credit card replenishment,you authorize New Jersey  E-ZPass   to automatically charge yourcredit card for your replenishment amount.b) By selecting direct debit of your bank checking account for replenishment, you authorize New Jersey E-ZPass   to automatically debit your bank checking account for your replenishment amount.c) You can mail a check to the New Jersey  E-ZPass   Customer Service Center or hand-deliver it to any ofthe New Jersey  E-ZPass   Walk-in Center locations. Checks should be made payable to EZPass. A returned check fee of $25 will be charged for each check returned to New Jersey  E-ZPass   forinsufficient funds.d) Cash payments must be made in U.S. dollars in person at any of the New Jersey  E-ZPass   Walk-InCenter locations. DO NOT SEND CASH IN THE MAIL.e) If you have chosen to replenish your Account with a credit card, you may enroll in the  E-ZPass   Plus SM program by contacting the New Jersey  E-ZPass   Customer Service Center and requesting that the E-ZPass   Plus program be added to your Account. This program allows you to use your  E-ZPass   tag atauthorized  E-ZPass   Plus facilities. If your Tag is used to incur  E-ZPass   Plus charges, any charges of $20or more will be directly charged to your credit card by New Jersey  E-ZPass  . Charges under $20 will bededucted from your pre-paid balance.Such credit card charges may be different from your replenishmentamount and charged to your credit card at any time. By participating in  E-ZPass   Plus, you consent to therelease of your name and address to  E-ZPass   Plus facility operators for collection purposes.f) Depending on usage or other charges to your Account, there may be more than one replenishmenttransaction in one statement period. ➏  TAG MISUSE, ADMINISTRATIVE FEES, ORPHAN TRANSACTIONS, DISPUTED CHARGES Improper use of your  E-ZPass   tag(s) or failure to pay the proper toll may result in the imposition of anadministrative fee or other charges as follows:a) If you use your tag(s) when your Account has a negative balance, is suspended or revoked, or if youuse a tag that has been reported as lost or stolen, you may incur an administrative fee of up to $50(per occurrence),may be charged the full undiscounted toll,and may be asked to surrender your tag(s).b) If you use a valid tag in a vehicle other than the type of vehicle for which the tag is designated, youmay incur administrative fees of up to $50 (per occurrence) and may be asked to surrender your tag(s).Such continued misuse may also result in revocation of your Account.c) If you attempt to use a tag without properly attaching it to your vehicle in accordance with theinstructions in the  E-ZPass   Customer Reference Guide you received when your Account was opened,you may incur an administrative fee of up to $50 (per occurrence).d) On the New Jersey Turnpike, orphan transactions can occur when, due to equipment failure or usermisuse, a tag is not read at either the vehicle entry or exit point or both. In these events, the actual tollcannot be determined and the toll amount charged will be based upon the vehicle’s class and the followingrules: (a) if the tag is not read on entry for whatever reason, but is read at exit, the maximum fare will becharged; or (b) if the tag is not read for whatever reason at both the entry and exit, but the license plateon the vehicle is read, the median fare for the applicable exit interchange will be charged to the Accountassigned to that license plate. If New Jersey  E-ZPass   determines that the orphan transaction is a resultof user misuse or improper installation of the tag in the vehicle, New Jersey  E-Z Pass   reserves the rightto a charge an administrative fee of up to $50 (per occurrence) in addition to the toll charged. Otherfacilities accepting  E-ZPass   outside the State of New Jersey may have similar policies. You agree to abideby the policies of those facilities consistent with section 2 of these Terms and Conditions.e) Tags must be removed from any vehicle under tow. If tags are not removed, your Account may becharged for any and all tolls incurred in connection with the towing of such vehicle.f) Administrative fees and charges may be billed directly to your Account. You may only contest theimposition of charges or administrative fees to the New Jersey  E-ZPass   Customer Service Center. Anysuch challenges must be made in writing within 60 days of the issuance of the first Account Statementreflecting the disputed charge. If the fee is rescinded, your Account will be credited the amount of therescinded fee or charge. ➐  LOST OR STOLEN TAGS  You must notify New Jersey  E-ZPass   immediately upon discovery of the theft, loss or unauthorized use ofyour  E-ZPass   tag(s) by either calling 1-888-AUTO-TOLL (1-888-288-6865) or reporting it on the website(www.EZPassNJ.com) to the New Jersey  E-ZPass   Customer Service Center. If notification of the loss ortheft is made to New Jersey  E-ZPass   in a timely manner, via one of the methods listed above, you will notbe liable for unauthorized charges in excess of $49.99 made to your Account prior to receipt of notificationof loss or theft, or for any charges resulting from the unauthorized use of your tag(s) after the receipt ofnotification of loss or theft. A fee may be charged to your Account for any lost or stolen tag(s) that wereleased to you. If you purchased your tag(s) you may be charged a fee to replace the tag(s) as provided insection 16. If your tag was stolen, notification of the theft is made to New Jersey  E-ZPass   in a timelymanner, and you provide the New Jersey  E-ZPass   Customer Service Center with a written copy of a policereport of the tag’s theft, you will not be charged any fees for the stolen tag or for a replacement tag. ➑  DEFECTIVE TAGS If your New Jersey  E-ZPass   tag(s) is non-operational for reasons other than abuse or improper use, and thetag is returned to the New Jersey  E-ZPass   Customer Service Center, it will be replaced at no extra chargeto you. If New Jersey  E-ZPass   determines that abuse or improper use has rendered your tag(s) non-operational, a fee for the tag(s) may be charged to your Account. ➒  DISCLAIMER To the extent permitted by law, New Jersey  E-ZPass   expressly disclaims any representation of warranty,expressed or implied, relating to the New Jersey  E-ZPass   tag including, without limitation, any implied orexpressed warranty or merchantability, fitness for a particular purpose or conformity to models or samples.Nor is New Jersey  E-ZPass   liable for any third party act taken by reason of your use or display of the NewJersey  E-ZPass   tag. You agree to indemnify New Jersey  E-ZPass   and hold New Jersey  E-ZPass   harmlessfrom and against any and all damage, loss, cost, expense, or liability relating to, arising from, or as a resultof the use or performance of the New Jersey  E-ZPass   tag. ➓  TERMINATION  You may terminate this Agreement at any time by writing to the New Jersey  E-ZPass   Customer ServiceCenter that your Account be closed, returning all of your leased New Jersey  E-ZPass   tag(s) in good workingcondition (except for normal wear) and settling any outstanding charges on your Account. Tags can bereturned in person to any of the New Jersey  E-ZPass   Walk-in Center locations or by mail to the New Jersey E-ZPass   Customer Service Center. Leased tag(s) issued to you that have been lost or stolen must bereported to us and any charges applicable to such tag(s) will be applied to your Account consistent withsection 7 of these Terms and Conditions. Tag(s) returned to New Jersey  E-ZPass   not in good workingcondition or that have been defaced will result in a fee being charged to your account for each such tag asper section 16.All outstanding charges will be deducted from the funds in your Account with any remainingbalance refunded to you by applying a credit to the credit card you have on file, or, if there is no credit cardon file, by issuing a refund check to you. Your Account will remain active with charges and fees, includingthe monthly membership fee, continuing to be applied until all outstanding balances are settled, you havereported all lost or stolen tag(s), and all leased tag(s) still in your possession have been returned to the NewJersey  E-ZPass   Customer Service Center. You agree that we may terminate your New Jersey  E-ZPass   Account for improper use at any time, and without notice. ⓫  COLLECTION EXPENSES  You agree to pay all costs, including legal fees, incurred by New Jersey  E-ZPass   to collect any monies dueunder the terms of this Agreement. ⓬  MODIFICATION New Jersey  E-ZPass   may change the Terms and Conditions at any time, including changing any existingfees or imposing new fees. A copy of the revised Terms and Conditions, including the effective date, willbe included with your Account statement, and will be delivered to you in the same manner you have chosenfor delivery of your Account statement. A copy of any revised Terms and Conditions will also be mailed toyou upon request. Your first use of a tag following the delivery of any new Terms and Conditions willconstitute your acceptance of those new Terms and Conditions. You may choose to opt out and decline thechange in Terms and Conditions by not using the tag(s) after the effective date for the new Terms andConditions and returning all your  E-ZPass   tag(s) pursuant to Section 10. The invalidity of any term or termsof this Agreement shall not affect any other term of this Agreement which shall remain in full force andeffect.You agree to inform New Jersey  E-ZPass   in writing, by calling 1-888-AUTO-TOLL (1-888-288-6865)or through the New Jersey  E-ZPass   website (www.EZPassNJ.com) of any changes to the informationprovided by you in your New Jersey  E-ZPass   application, including:ã Change in addressã Change in vehicle information (new car, license plate, etc.)ã Change in credit card account status (closed account, maximum credit use)ã Expiration date of credit card account ⓭  GOVERNING LAW ThisAgreement shall be governed by and construed in accordance with the laws of the State of New Jersey. ⓮  NON-DISCLOSURE Customer account information will not be disclosed to third parties without your consent except aspermissible by law. ⓯  INQUIRIES AND CORRESPONDENCE Please send applications, inquiries and correspondence, tag returns, payments or violation inquiries to: Applications: Violation Inquiries: NJ  E-ZPass   Cust. Service Center NJ  E-ZPass   Cust. Service CenterP.O. Box 52001 P.O. Box 52005Newark, NJ 07101-8201 Newark, NJ 07101-8205 Payments: Inquiries, Correspondence and Tag Returns: NJ  E-ZPass   Cust. Service Center NJ  E-ZPass   Cust. Service CenterP.O. Box 52002 P.O. Box 52003Newark, NJ 07101-8202 Newark, NJ 07101-8203 Telephone Inquiries:  All non-violations telephone inquiries may be made toll free by dialing 1-888-AUTO-TOLL (1-888-288-6865). Violations telephone inquiries may be made by dialing 1-973-368-1425. ⓰  SCHEDULE OF DEPOSITS/ADMINISTRATIVE FEES Monthly Membership Fee: $1.00Per Tag deposit (leased tag customers): $10.00Duplicate copy statement fee: $0.75 regular mail $0.11 e-mailTag purchase fee: Interior: $9.00 Exterior: $15.00Fee for defaced, damaged, lost or stolen tag: Interior: $9.00 Exterior: $15.00Returned check fee: $25.00Tag misuse: up to $50.00 (per occurrence) Violation administrative fee: up to $50.00 (per occurrence)New Jersey  E-ZPass   and the entities providing  E-ZPass   services reserve the right to assess additional fees.Effective date - 4/2012 E-ZPass   Business Agreement Terms and Conditions  1 6 Special Vehicle Listing: Exterior Tags Required as of 5/04 The vehicles listed below are equipped with special windshields that may contain metal in the glass that prevents the  E-ZPass   tag from beingread properly. Customers with these windshields must obtain exterior tags.There may be other vehicles that have specialized windshields asan option that may prevent an  E-ZPass   tag from being read properly.If you are unsure about whether your vehicle has one of these windshields,contact the dealer where you purchased your car. Make Model All Buick   Roadmaster All Cadillac  Catera 1999-2001 Chevrolet  Lumina Van Prior to 2002 Venture Prior to 2002 Ford  Crown Victoria* 1987-1994Taurus* Prior to 1995 Oldsmobile  Silhouette Prior to 2002 Pontiac  Montana Prior to 2002Transport Prior to 2002 Subaru  SVX All *Vehicles with heated windshields Paying for parking is now quicker and easier with The easy way to pay for airport parking. Use E-ZPass Plus at the following locations:  JFK International Airport LaGuardia Airport Newark Newark Liberty International AirportAlbany Airport New York Avenue Garage, Atlantic City Atlantic Avenue Parking Lot, Atlantic City Leaving the parking facilities at Atlantic City's New York Avenue Garage and Atlantic AvenueParking Lot, JFK International Airport, LaGuardia Airport, Newark Liberty International Airportor Albany Airport is quicker and easier with E-ZPass Plus – the automated parking system thatallows E-ZPass customers to use their E-ZPass tag to pay for parking. To qualify for thisprogram, you must replenish your E-ZPass account with a valid credit card. Enrollment in thisprogram is simple, place a checkmark in the box for E-ZPass Plus (Part 1 - CompanyInformation) when completing your application. New Jersey  E-ZPass   Customer Service and Walk-In Centers New Jersey E-ZPass Main Customer Service Center P.O. Box 52003Newark, NJ 07101-8203 1-888-AUTO-TOLL (1-888-288-6865) www.EZPassNJ.com TDD/TTY 1-866-205-4000 Walk-In Center Locations Newark Walk-in Center 375 McCarter Highway ã Newark, NJHours: Mon. - Fri. 7am – 7pm, Saturday 8am – 2pm Camden Walk-in Center 420 N. 6th Street ã Camden, NJHours: Mon. - Fri. 8am – 6pm Delaware Memorial Bridge Plaza I-295 and New Castle Avenue ã New Castle, DEHours: Mon., Tues., Wed., and Fri.: 9am-4:45pmThurs. from 7am-6:45pm Instructions for Completing the E-ZPass Business Application The name on the account must be the full legal company name. Clearly print yourcompany information. You must provide the last 4 digits of your Federal ID #, whichwill serve as your PIN number. Your PIN number will be used for identificationpurposes when you access your account via the phone system or website.Please record your PIN number hereand retain it for future reference.Please provide the requested information for each vehicle listed on the VehicleInformation Forms. ã FOR BUSINESS VEHICLES (PART 2a) Enter license plate number, state/province of registration, make and modelof vehicle, vehicle reference number and number of axles. Circle the typeof tag that you are requesting,either interior windshield,exterior roofmountor exterior license plate. TOTAL NUMBER OF AXLES (BOX A, pg. 3) Total the number of axles column from the Business VehicleInformation section. Enter the total in Box A. TOTAL NUMBER OF INTERIOR WINDSHIELD TAGS (BOX B, pg. 3) Total the number of vehicles that have Windshield circled. Enter thetotal in Box B. TOTAL NUMBER OF EXTERIOR ROOFMOUNT TAGS (BOX C, pg. 3) Total the number of vehicles that have Roofmount circled. Enter thetotal in Box C. TOTAL NUMBER OF EXTERIOR LICENSE PLATE TAGS (BOX D, pg. 3) Total the number of vehicles that have License Plate circled. Enterthe total in Box D.Note: Do not order an interior tag for vehicles that have flat, perfectlyvertical windshields or for vehicles that have any metal hanging over thewindshield (i.e., visor, storage rack, boom or crane). If your vehicle fits thisdescription, you must order an exterior tag. ã FOR BUSINESS VEHICLES (PART 2b) Enter the license plate number, state/province of registration, make andmodel of vehicle, vehicle reference number from the enclosed “VehicleReference Chart” and number of axles. ã FOR PASSENGER VEHICLES (PART 2c) Clearly print license plate number, state/province of registration, vehiclemake and model and vehicle reference number.Circle the tag type for eachvehicle for which you are requesting a tag. If you are not requesting a tagfor a vehicle,circle None .Please refer to the SpecialVehicle Listing.If anyof the listed vehicles appear on this list, you must request an exterior tag. TOTAL NUMBER OF INTERIOR WINDSHIELD TAGS (BOX E, pg. 5) Total the number of vehicles that have Windshield circled. Enterthe total in Box E. TOTAL NUMBER OF EXTERIOR LICENSE PLATE TAGS (BOX F, pg. 5) Total the number of vehicles that have License Plate circled.Enter the total in Box F.To open an account, you must make an Initial Payment that includes the purchaseprice of tags and a prepaid toll balance equal to your account’s estimated 45-day tollusage. ã PREPAID TOLLS Box 1 Toll Usage = Enter your estimated 45-day toll usage for your account. ã TAG COSTS Business accountholders are required to purchase their own tags(interior - $9.00, exterior - $15.00)Box 2 Number of Interior Tags requested = total of Boxes B and E(pgs. 3 & 5), enter the amount in Box 2.Box 3 Multiply the number in Box 2 by $9.00, enter the amount in Box 3.Box 4 Number of Exterior Tags requested = total of Boxes C, D and F(pgs. 3 & 5), enter the amount in Box 4.Box 5 Multiply the number in Box 4 by $15.00, enter the amount in Box 5.Box 6 Total Tag Cost = Box 3 + Box 5, enter the amount in Box 6.Box 7 Total Initial Payment = Box 1 + Box 6, enter the amount in Box 7. ã CREDIT CARD REPLENISHMENT: The Easiest Way to Pay There are many advantages to starting and replenishing your E-ZPassaccount with a credit card:ã It’s easy. There’s no need to worry about a separate E-ZPass payment.ã It’s automatic. As long as your credit card account is in goodstanding, your E-ZPass balance will never run out.ã It’s convenient. Your account is automatically charged wheneveryour account balance falls below 25% of your prepaid toll amount.To replenish by credit card, place a checkmark in the box to the left of Option 1 and complete Part 5.A secondary credit card option is availableto the customer in case the primary credit card does not processcorrectly. Provide E-ZPass with your current credit card number, creditcard type, expiration date and signature. Your credit card must alwaysbe valid and have a current expiration date. ã DIRECT PAYMENT FROM BANK CHECKING ACCOUNT To replenish by direct payment from a bank checking account, place acheckmark in Option 2. Enclose a voided check from your bank checkingaccount. You must enclose a check or money order for the amount computed in theTotal Initial Payment of the application or supply your credit card number inPart 5 (Primary Credit Card Number) of the application to have the amountlisted in the Total Initial Payment box charged to your credit card. ã CHECK OR CASH PAYMENT To replenish by check or cash, place a checkmark in the box in “Option 3.”Cash payments must be made in person at any of our New Jersey E-ZPassWalk-in Center locations listed on the insert. Otherwise, enclose a check payable to E-ZPass for the amount shown in Box 7 of Part 3 and mail withthis application.This section must be signed by a duly authorized representative of the company. PART 1. COMPANY INFORMATION PART 2. VEHICLE INFORMATION PART 3. PRE-PAYMENT CALCULATION  If you need further assistance in completing this application or updating your account information,please take advantage of our automated phone system by calling 1-888-AUTO-TOLL (1-888-288-6865) or access our website at www.EZPassNJ.com to: ã Receive account information. ã Report a lost or stolen tag.ã Service Center location and hours of operation. ã Request an application.ã Update your credit card expiration date. ã Check your account balance.Please have your account or tag number and PIN # ready when you call. PART 6. CUSTOMER AGREEMENT PART 4. PAYMENT METHODS    5 2 Primary Credit Card Number: Expiration Date: ______/______ Secondary Credit Card Number: Expiration Date: ______/______Credit Card Type:    Visa Mastercard    American Express    Discover  Credit Card Type:    Visa Mastercard    American Express    Discover BUSINESS APPLICATION New Jersey Customer Service Center    Individual accounts with more than four tags   For company-owned or leased passenger and business vehicles (i.e., cars, trucks, tractor trailers, tandem trailers, etc.)   Call 1-888-AUTO-TOLL (1-888-288-6865) or access our website at www.EZPassNJ.com to make any change to an existing E-ZPass account or if you are an Individual Account Customer   FOR INSTRUCTIONS  on completing this application, please see page 1 New Jersey E-ZPass Customer Service CenterP.O. Box 52001Newark, NJ 07101-8201 1. COMPANY INFORMATION  Personal Identification Number PART 2. VEHICLE INFORMATIONPART 3. PRE-PAYMENT CALCULATIONPART 4. PAYMENT METHODPART 5. CREDIT CARD INFORMATIONPART 6. CUSTOMER AGREEMENT I have read the information on this application and the Terms and Conditions. I authorize payment as selected, and certify that all information contained in the application is true and accurate.  E-ZPass Applicant Signature Required: _________________________________________________________________________________ Date: ______/______/______  Option 1  - Credit Card with Automatic Replenishment  You authorize E-ZPass to immediately charge your credit card (enter Information in section 5, Credit Card Information) the amount shown above in the Initial Payment (Line G). Whenever your prepaidbalance falls to 25% of the scheduled replenishment amount or $10, whichever is greater, you authorize E-ZPass to charge your credit card the replenishment amount. Should you fail to return your tagsor require a replacement, or incur administrative fees or E-ZPass Plus charges, you authorize E-ZPass to charge your credit card the appropriate amount incurred under the terms of this agreement. Youunderstand and agree that such charges will continue until your Account is terminated or closed or you revoke this authorization in writing. You authorize E-ZPass, in its discretion, to receive updatedinformation about your credit card, including new account numbers and expiration dates, from the financial institution issuing your card.  Option 2   - Debit from Bank Checking Account Replenishment  Note: To use this option, you must initially fund your account using a credit card, check or money order  You authorize E-ZPass to immediately debit your bank checking account the amount shown above in the Initial Payment (Line G).Whenever your prepaid balance falls to 25% of the scheduled replenishmentamount or $10, whichever is greater, you authorize E-ZPass to debit your bank checking account the replenishment amount. (A voided check from your checking account must accompany this application.)Should you fail to return your tags or require a replacement, or incur administrative fees, you authorize E-ZPass to debit your bank checking account the appropriate amount incurred under the terms ofthis agreement. You understand and agree that such charges will continue until your Account is terminated or closed or you revoke this authorization in writing.  Option 3   - Check or Cash Replenishment Make checks payable to E-ZPass and mail with this application to the New Jersey E-ZPass Walk-in Customer Service Center, PO Box 52001, Newark, NJ 07101-8201. Make cash payments in personat any of the New Jersey E-ZPass Walk-in Center locations listed on the insert. A low balance message will display in the toll lane whenever your prepaid amount is at approximately 50% of yourreplenishment amount indicating that a payment is required. DO NOT MAIL CASH.Corporate / Business Name:Billing Contact: Last Name: First Name: Phone Number: Fax Number: ( ) ( ) Billing Address: City: State: Zip Code:Shipping Contact: (if different from above) Last Name: First Name: Phone Number: Fax Number: ( ) ( ) Shipping Address: City: State: Zip Code:I would like to receive my statement:  (Please Check One)    E-mail E-mail address  _____________________________________________________    Regular Mail    CD    Do not send statement   I would like to enroll in the E-ZPass Plus program.  (Specific details of this program are listed on page 6.) Complete the attached Vehicle Information forms (Parts 2a, 2b and 2c) before completing Part 3. List all vehicles even though tags may not be ordered for all vehicles at this time. Use of a tag on a vehicle of a different toll class may result in an administrative fee, in addition to the toll. You may also be liable for civil penalties pursuant to law. Refer to Page 1 for instructions on completing Part 2. Month Year Month Year TOLL USAGE TOTAL PREPAID TOLL (Box 1 = Your account’s estimated 45 day/toll usage.) Actual toll usage will be evaluated 35 days afteropening an account and 90 days thereafter. Your monthly prepaid adjustment amount will beadjusted according to actual usage.Box 1 TOLL COST Note: Business accountholders are required to purchase their own tags - Interior: $9.00 Exterior $15.00 x $9.00 = Number of Interior Tags (Box 2 - Total of Box B and Box E on page 3 and 5.) x $15.00 = Number of Exterior Tags (Box 4 - Total of Box C, D and F on page 3 and 5.)Box 2Box 4Box 3Box 5Box 6Box 7 TOTAL TAG COST (Box 6 = Box 3 + Box 5) TOTAL INITIAL PAYMENT (Box 7 = Box 1 + Box 6) } BOX E BOX F Total # of Total # oftags circled tags circled Totals: PART 2c. PASSENGER VEHICLE INFORMATION List all passenger vehicles that may be used under this account even if you are not requesting a tag for the vehicle at this time.Attach photocopies of this sheet ifmore space is needed.The vehicle type selected from the Vehicle Reference Chart should be the most common configuration of that vehicle.All passenger vehicleswill be issued interior tags, unless the vehicle appears on the Special Vehicle Listing requiring exterior tags.  To avoid violations, if your license plate changes,please contact the New Jersey E-ZPass Customer Service Center.License Plate State / Vehicle Vehicle Vehicle You Must Circle One Type Of TagNumber Province Make Model Reference # For Each Vehicle (Please Print Clearly)  of  (From Vehicle Registration  Reference Chart)  Interior Tags Exterior Tags NoneVehicle1Vehicle2Vehicle3Vehicle4Vehicle5Vehicle6Vehicle7Vehicle8Vehicle9Vehicle10Vehicle11Vehicle12Vehicle13Vehicle14Vehicle15Vehicle16Vehicle17Vehicle18Vehicle19Vehicle20Vehicle21Vehicle22Vehicle23Vehicle24Vehicle25 Windshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate NoneWindshield License Plate None  3 4BOX A BOX B BOX C BOX D Total # Total # of Total # of Total # ofof axles tags circled tags circled tags circled Totals: PART 2a. BUSINESS VEHICLE INFORMATION List all business vehicles that will be used under this account,that you are requesting a tag for at this time.Attach photocopies of this sheet if more space is needed.The vehicle type selected from the Vehicle Reference Chart should be the most common configuration of that vehicle.  To avoid violations, if your license platechanges, please contact the New Jersey E-ZPass Customer Service Center.License Plate State / Vehicle Vehicle Vehicle No. of You Must Circle One Type Of TagNumber Province Make Model Reference # Axles For Each Vehicle (Please Print Clearly)  of  (From Vehicle Registration  Reference Chart)  Interior Tags  Exterior TagsVehicle1Vehicle2Vehicle3Vehicle4Vehicle5Vehicle6Vehicle7Vehicle8Vehicle9Vehicle10Vehicle11Vehicle12Vehicle13Vehicle14Vehicle15Vehicle16Vehicle17Vehicle18Vehicle19Vehicle20Vehicle21Vehicle22Vehicle23Vehicle24Vehicle25 Windshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License PlateWindshield Roofmount License Plate PART 2b. BUSINESS VEHICLE INFORMATION (NOT REQUESTING TAGS AT THIS TIME) List business vehicles that may be used under this account even though you are not requesting a tag(s) for them at this time. Attach photocopies of this sheetif more space is needed.The vehicle type selected from the Vehicle Reference Chart should be the most common configuration of that vehicle.  To avoid violations,if your license plate changes, please contact the New Jersey E-ZPass Customer Service Center.License Plate State / Vehicle Vehicle Vehicle NumberNumber Province Make Model Reference # of Axles (Please Print Clearly)  of  (From Vehicle Reference Chart) RegistrationVehicle1Vehicle2Vehicle3Vehicle4Vehicle5Vehicle6Vehicle7Vehicle8Vehicle9Vehicle10Vehicle11Vehicle12Vehicle13Vehicle14Vehicle15Vehicle16Vehicle17Vehicle18Vehicle19Vehicle20Vehicle21Vehicle22Vehicle23Vehicle24Vehicle25
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