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MC04194 Visitor Pass Forms

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MC04194 Visitor Pass Forms Powered By Docstoc
					                            Boston Multi-Day LinkPass
                            Groups (50+) Order Form

Please complete this form   MBTA REVENUE DEPARTMENT
and send with payment to:   Ten Park Plaza, Room 3620
                            Boston, MA 02116
                            Attention: Multi-Day LinkPass


      Method of payment:    Certified, Cashier or Business Check
                            No cash, personal checks or credit cards.

                            Please Print:

                 Ship to:   Organization Name ____________________________________________________________


                            Address _____________________________________________________________________


                            City _________________________________________ State _________ Zip _____________


                            Contact Name ________________________________ Title ___________________________


                            Contact Telephone ____________________________ Fax ___________________________


                            e-mail _______________________________________________________________________


                            Exact Date of Travel: __________________________________________________________


  Choose your pass type:    PASS TYPE                QUANTITY                  UNIT PRICE             AMOUNT


                            1 Day                    ________           x         $8.50               $ ___________


                            7 Consecutive Day        ________           x         $14.00              $ ___________
   Note: Must order
 50 or more passes.         TOTALS                   _________          CHECK DUE FOR TOTAL           $ ____________



        Please sign here:   Signature of Applicant ______________________________ Date _____________________

                                                                   Please allow two weeks for processing upon receipt.

				
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