Bus Ticket & Pass Mail Order Form
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1BUS TICKET & PASS MAIL ORDER FORM
To request passes and tickets by mail, please complete he following and include a check or money order.
Please do not send cash. Your order will be mailed to you within four business days. Please mail your
completed form and payment to:
WHEELS, ATTN: CUSTOMER SERVICE
1362 RUTAN COURT, SUITE 100, LIVERMORE, CA 94551-7318
The Livermore Amador Valley Transit Authority is not responsible for mail-in orders not delivered by the US
Post Office. Questions? Please call 925-455-7500
SECTION 1: All fields must be filled in to process the order. Please print legibly.
NAME
ADDRESS (INCLUDING APARTMENT NUMBER) CITY
STATE
ZIP CODE
PHONE NUMBER
DRIVER’S LICENSE OR ID NUMBER
EXPIRATION DATE
SECTION 2: Please enter a quantity for each type of ticket or pass you want to purchase.
OFFICE USE ONLY
COST
QUANTITY
TOTAL
ISSUED
DATE
FareBuster 10-1/Ride Tickets
$16.00
X
= $
East Bay Value Pass
$60.00
X
= $
Indicate Month_________________
Senior Monthly Pass
$18.00
X
= $
Indicate Month_________________
Disabled Monthly Pass
X
$18.00
= $
Indicate Month_________________
Senior/Disabled 1-Ride Ticket
$1.00
X
= $
Senior/Disabled 10-1/Ride Tickets
$10.00
X
= $
Dial-A-Ride 1-Ride Ticket
$3.50
X
= $
BART Tickets
BART Green ($24 Value/Senior 65+)
$9.00
X
= $
BART Red ($24 Value/Youth & Disabled)
$9.00
X
= $
TOTAL AMOUNT ENCLOSED
$
Fares effective March 22, 2009
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Parent category: Business