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SENIOR APPLICATION - docs.clippercard.com

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OFFICE USE ONLY: Intake Date ________________ Transit Agency ___________________________ Employee Name _________________________________01/2016 SENIOR APPLICATIONAPPLICATION INSTRUCTIONSComplete and submit this APPLICATION to obtain a free SENIOR Clipper card. All applications must be accompanied by a copy of proof-of-age documentation. Cards are available for adults 65 and older. Step 1: CARDHOLDER CONTACT INFORMATION All fields in Step 1 are required except Name _______________________________________ Middle Initial _____ Last Name ________________________________________ _Address ________________________________________ _______ Apt # _____ City __________________ State _____ Zip Code __________Day Phone ______________________________________ Email Address (optional)______________________________ __________________Step 2: CARDHOLDER PROOF-OF-AGE DOCUMENTCheck the one document you are submitting and write its number below. Only send photocopies. Do not send original documents.

OFFICE USE ONLY: Intake Date _____ Transit Agency _____ Employee Name _____ 01/2016

  Applications, Senior, Senior application

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Bay Area transit systems. Bay Area Clipper PUB: 12/17 clippercard.com PD: 12/17 Visit clippercard.com for a full list of retail, customer service center, ticket machine and Add Value machine locations. Clipper Bay Area Rapid Transit (BART) Your All-in-One Transit Card Use Clipper on these transit services: AC Transit BART Caltrain City …

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YOUTH APPLICATION - docs.clippercard.com

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Step 5: SUBMIT APPLICATION MAIL your application form and a copy of your proof-of-age document to: Clipper Youth/Senior Applications, PO Box 318, Concord, CA 94522-0318. Do not send originals, as documents will not be returned. Or EMAIL scans or photos of your application form and your proof-of-age document to . senioryouthapps@clippercard.com.

  Applications, Senior, Senior application

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