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CLIPPER YOUTH AND SENIOR APPLICATION

YOUTH AND SENIOR APPLICATION . APPLICATION INSTRUCTIONS. Complete and submit this APPLICATION to obtain a free YOUTH or SENIOR CLIPPER card. All applications must be submitted with a copy of proof-of-age documentation. DISCOUNTED FARES. YOUTH and SENIOR CLIPPER cards calculate discounted fares based on age and eligibility. Cards are available for YOUTH 5 to 18 and seniors 65 and over. Step 1: CARDHOLDER CONTACT INFORMATION All fields in Step 1 are required except email. First Name Middle Initial Last Name Address Apt # City State Zip Code Day Phone Email Address (optional). Step 2: CLIPPER ACCOUNT INFORMATION Step 3: CARDHOLDER PROOF-OF-AGE DOCUMENT. What type of card are you applying for? Check the one document you are submitting and write its number below. Only send photocopies. YOUTH CLIPPER Card (5-18). Do not send original documents. SENIOR CLIPPER Card (65 and over) Birth certificate or passport State-issued ID card or driver's license For your protection, CLIPPER requires you to provide Permanent resident card ( Green Card ).

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.

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