Get FasTrak Account Closure Form

FasTrak Customer Servic Center ce PO Box 26926 San Fran ncisco CA 94126 www. bay yareafastrak. org 1-877-BA AY-TOLL 1-877-229-8655 Fax 1-41 15-956-1663 Account Closure Form A FasTrak Account Numbe er or if unkn nown provide Toll Tag Number N Name/Com mpany Address City State ZIP Day Phone e Evening Ph hone P Please check th box to indic you will no his cate ot retur your toll tag rn g s. r Number of Tags Returned Important Toll tags MUS be returned with your acc UST d count closure r request. A 20. 00 fee will be c charged for ea ach unreturned toll tag. No additional cred a dits/refunds wil be given if to tags are retu ll oll urned after the account is clo osed* f om Refund Address if different fro above Note Refu unds will be pro ocessed in approximately 30 days to allow f posting of t for transactions af request is fter submitted* For cash/chec accounts ref ck funds will be made by check. For credit car accounts a credit will be i m rd issued to the cred card on the account. dit Signatur re All parties listed on account Date must sign For a bus siness account an Account Closure Form must be signed by the contact listed on the a C t account. If ther are multiple co ontacts listed only one contact is required to sign the Acc o Form* If there are no contac cts listed a let requesting to close the ac tter g ccount on business letterhead must be subm mitted and sign by an officer of ned the compan ny. Reason for Closure Movi New Addr Provided Above ing ress Chan nged Job/Retire Death of Account Holder h H For verification please include a copy of the death certificate a copy of the Power of Atto p te orney if an esta has been establishe or other doc b ed cumentation e obituary f e*g* funeral pamphl etc*. let Not Happy with Se ervice Plea Explain ase Othe Please Expla ain Please ra our cust tomer servic Exce ellent Above Average Av verage Poor OFFI FICE USE ONLY Y Closing Bal lance Toll Tag D Deposit Method of Payment Total Refund Ca ash/Check Vis sa MasterCar Amex D Discover CSR Date Finan Initials nce. r Number of Tags Returned Important Toll tags MUS be returned with your acc UST d count closure r request. A 20. 00 fee will be c charged for ea ach unreturned toll tag. No additional cred a dits/refunds wil be given if to tags are retu ll oll urned after the account is clo osed* f om Refund Address if different fro above Note Refu unds will be pro ocessed in approximately 30 days to allow f posting of t for transactions af request is fter submitted* For cash/chec accounts ref ck funds will be made by check. A 20. 00 fee will be c charged for ea ach unreturned toll tag. No additional cred a dits/refunds wil be given if to tags are retu ll oll urned after the account is clo osed* f om Refund Address if different fro above Note Refu unds will be pro ocessed in approximately 30 days to allow f posting of t for transactions af request is fter submitted* For cash/chec accounts ref ck funds will be made by check. For credit car accounts a credit will be i m rd issued to the cred card on the account. dit Signatur re All parties listed on account Date must sign For a bus siness account an Account Closure Form must be signed by the contact listed on the a C t account.