Wageworks Employee Enrollment Form - Mj Boyd Consulting

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Enrollment / Change Form
Transit and Parking
Save up to 40%* on $130 worth of monthly transit expenses and/or $250 worth of eligible
Save Money – Use Passport to
parking** expenses in 4 easy steps:
pay with pre-tax dollars and
1. Use the order form below to tell your company how much you want to contribute each month
save up to 40% on the cost of
to your commuter benefits program. Please note: Transit amounts may only be spent on
transit passes.
transit, and Parking amounts may only be spent on eligible parking** — they cannot be mixed.
Save Time – Get your transit
2. A Transit and/or Parking Account will be set up on your behalf. A $70 train ticket will cost you
pass delivered free to your
only about $42. A $120 monthly parking space will cost you about $72.* If your pass or parking
home, or your parking
cost is more than the pre-tax limit, you can pay the balance with a personal credit card.
payment sent directly to
your parking provider.
3. Use your Transit Account to buy transit passes and vanpool vouchers from our online catalog
at Use your Parking Account to place your parking order.
Go to
and click on the Public
4. Get your transit pass delivered free to your home or your parking payment sent directly to
your parking provider.
Transportation demo to see
our selection of thousands of
Also, Select “Every Month” at and you’ll automatically get the same transit,
transit passes and vanpool
vanpool or parking order every month until you change or cancel it. Or, place a new order each
vouchers from 330 metro
month at
areas in all 50 states.
Please complete the following and return to:
1. Employee Name: ____________________________________________________
Office Phone Number: _______________________________________________ _
E-mail: _____________________________________________________________
ID Code (last 4 digits)† : ______________________________________________
2. This is (check one):
 New Transit Account Election (effective _______________ 1st, 20___ )
 New Parking Account Election (effective _______________ 1st, 20___ )
 Change of Transit Account Election (effective ___________ 1st, 20___ )
3. A. Please enter the Transit election you want each month: $ _______________
(Any amount between $25 and $130. This amount can be exact, i.e. $75.25.)
B. Please enter the Parking election you want each month: $ _____________
(Any amount between $25 and $250. This amount can be exact, i.e. $185.75.)
4. Employee Signature: ________________________________________________
By submitting this form on paper or electronically you agree that your employer
is authorized to deduct the amount you elected from your regular pay.
* You save taxes on the first $130/month in eligible transit and vanpool expenses and the first $250 in eligible parking expenses. If your
federal marginal tax rate is 28%, your state marginal tax rate is 4.35%, and you pay FICA (including Medicare) of 7.65%, then you will save
40%, or $28 on a $70 pass and $48 on a $120 parking space. If your marginal tax rates are higher, you would save more, if lower, you would
save less.
** “Eligible Parking” is parking at or near work, or parking at or near public transportation you use to get to work. Visit
for more information.
† Your ID Code is the last 4 digits of your Social Security Number, your Employee Number or other reference number assigned by your
program sponsor. Please check the enrollment instructions provided by your program sponsor for more information about your ID Code.
WW-CX-ENROLL-TP-PRE (NOV 2013)

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