Fillable Commercial Account Application printable pdf download

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SUNPASS

COMMERCIAL ACCOUNT APPLICATION

SUNPASS PLUS AIRPORT PARKING

COMPANY INFORMATION

Check this box if you DO NOT want to enjoy the speed and convenience of using your

Company Name

transponders to pay for parking at Miami, Orlando, Ft. Lauderdale, Tampa and Palm

Beach International airports. To be a SunPass Plus customer, you must sign up for

SunPass

Easy Pay auto replenishment using a credit card.

Street Address

Apt.#

CUSTOMER AGREEMENT

City

County

State

Zip Code

I hereby agree to use the SunPass System in accordance with the terms and conditions of the SunPass

Customer Agreement. I understand that my SunPass transponder must be properly mounted

on the inside of the vehicle’s windshield. The transponder will allow passage on all

SunPass-equipped toll facilities and that the toll charges will be deducted from my SunPass

Contact Person: Last Name

First Name

Prepaid Account. If I do not agree with the stated terms and conditions of the Agreement, I will return

my SunPass Transponder within 45 days for a refund.

Phone Number

Extension Number

Authorized Signature:

Date:

Email Address (Will help you access your account online)

SUBMIT YOUR COMPLETED APPLICATION TO:

PERSONAL IDENTIFICATION NUMBER

Please enter a

4-digit (numeric)

number in the box provided. You

New Enrollments - Commercial Accounts

will need this number to verify your identity when requesting account information.

SunPass Prepaid Toll Program

PO Box 880029

Boca Raton, Florida 33488-0029

Fax: 1-888-265-1725

PREPAID ACCOUNT REPLENISHMENT OPTIONS

TRANSPONDER PURCHASE

SunPass PORTABLE can be purchased for $25.00 plus applicable sales tax. SunPass MINI can be

The SunPass Program

several convenient methods to replenish your Prepaid Account. Please

purchased for $4.99 plus applicable sales tax. A minimum initial prepaid balance of $50.00 is

select a replenishment option of your choice from the following methods:

required to pay for your initial toll usage.

OPTION A: IN PERSON OR BY MAIL (select one)

SunPass PORTABLE Transponders ordered ___________ @ $25.00 each

$0.00

Note: 30 days of average toll usage is the recommended replenishment amount.

I prefer to replenish my Prepaid Account in person with cash, check or money order at any

SunPass MINI Transponders ordered ___________ @ $4.99 each

$0.00

Wells Fargo Bank, or by simply mailing my payment using a check or money order to SunPass

Service Center. [SunPass Prepaid Toll Program, P.O. BOX 880049, Boca Raton, Florida 33488-0049]

TAXABLE SUBTOTAL

$0.00

I understand by selecting this option, SunPass Deposit Tickets will be mailed to me within 2-3 weeks.

I prefer to replenish my Prepaid Account in person with cash at an authorized SunPass

PLUS Florida sales tax for your county*

$0.00

Payment Center. (Visit for locations throughout the state of Florida.)

PLUS Initial Prepaid Account Balance - A minimum initial prepaid

No credit card or SunPass Deposit Tickets needed.

$0.00

balance of $50.00 is required.**

OPTION B: OR PHONE

TOTAL ENCLOSED FOR TRANSPONDER PURCHASE

$0.00

This option allows you to replenish your Prepaid Account with a major credit card online at

*Sales tax rates are to include Florida state sales tax of 6.00% plus county discretionary sales tax for the

county listed under “Company Information” above. Please verify the sales tax rate for your county at:

You may also replenish using our automated phone system or by speaking with a customer

service representative at 1-888-TOLL-FLA (1-888-865-5352).

**The SunPass Program will monitor your account’s activity and may adjust the required account balance

or low balance amount on actual usage.

OPTION C: AUTOMATIC CREDIT/DEBIT CARD REPLENISHMENT

This option authorizes the SunPass Program to automatically replenish your Prepaid Account by

Please select Option A or B indicating your payment method.

charging your card whenever your account drops to the low balance threshold you provide below.

Note: The low balance threshold is the balance your account must reach before it is

OPTION A: CHECK OR MONEY ORDER

replenished automatically. 15 days of average toll usage is the recommended low balance threshhold.

Low Balance Threshold: $ ________________________________

Check/Money Order Number

Amount

Automatic Replenishment Amount (Minimum $10.00): $ ________________________________

(Please make checks payable to Florida Department of Transportation.)

Authorization: I hereby authorize the SunPass Program to charge my credit card in the amount indicated

above whenever my Prepaid Account drops to my chosen low balance threshold. I understand this

OPTION B: CREDIT/DEBIT CARD

VISA

MASTERCARD

DISCOVER

AMEX

Please check one:

VISA

MASTERCARD

DISCOVER

AMEX

Authorized Signature

Date

Authorized Signature

Date

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Credit/Debit Card Number

Expiration Date

Credit/Debit Card Number

Expiration Date

01/2014

Commercial Account Application

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