Faculty & Staff Viking Xpress Bus Pass - Request Form/payroll Authorization

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Faculty & Staff Viking Xpress Bus Pass
Request Form/Payroll Authorization
Permanent faculty/staff paying by payroll deduction can use the e-sign form at https://esign.wwu.edu/admcs/process/forms/HR/Xpass.aspx
Mail completed form to Sustainable Transportation MS-9197
DO NOT MAIL PAYMENT WITH THIS FORM
Your pass will be delivered via campus mail. To make arrangements to pick up pass in person call 650-7960 or email
transportation@wwu.edu. The Sustainable Transportation office is in Viking Commons 25 and is open by appointment .
Last Name:
First Name:
Western ID:
Department:
Campus Phone:
Campus Mailstop:
Choose a pass: (check one option only)
Choose a payment method:
Academic year, $58* (Fall, Winter and Spring quarters)
Payroll deduction (permanent WWU employees only)
Available starting in September
If you select University Cashier or online payment, do not pay until
Fall quarter, $23** Available starting in September
we have notified you by phone or email that you have been charged.
Your pass will be mailed after payment is received.
Winter quarter, $23 Available starting in December
DO NOT MAIL PAYMENT WITH THIS FORM
Spring quarter, $23 Available starting in March
University cashier (cash, check or debit)
* Summer quarter, $40 (for those who purchased an
Academic Year Pass) Available starting in June
Online (electronic check or credit*)
** Summer quarter, $70 (for those who DID NOT
*MC/Discover/American Express, 2.75% convenience fee
purchase an Academic Year Pass) Available starting in
June
For Office Use
Terms:
 Viking Xpress passes are non-refundable
Date:
 Viking Xpress passes are available only to WWU faculty & staff,
and Aramark employees.
Quarter/Year of enrollment:
 Viking Xpress pass is to be used only by the purchaser
Entered By:
Payroll deduction:
 This deduction will be taken on a pre-tax basis
 This is a one-time deduction; the full amount will be deducted at
VXP #:
the next payroll.
Notes:
Employee Signature
Mail completed form to Sustainable Transportation MS-9197
DO NOT MAIL PAYMENT WITH THIS FORM

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