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Get PA 33-11B 2006

an account adjustment, you must complete and return this form within 45 days from the date of transaction with a ticket and/or receipt and a copy of your statement. INCOMPLETE REQUESTS WILL BE REJECTED AND RETURNED! Return to: J PTC E-ZPass Customer Service Center 7631 Derry Street Harrisburg, PA 17111 Returning Unused Ticket J Contest a Toll Charge J Other Please explain: PLEASE PRINT CUSTOMER INFORMATION Name: Address: State: City: Zip Code: Phone Number: Signature: E-ZPass Tran.

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