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Company Name   Date      *
Contact Name/Title    *   
Address (We do not deliver to P.O. Boxes or Box Zip Codes)   Suite/Floor/Room    * *
City   Zip   State * * *
Phone   Fax       *
Email (Important: To receive order and shipping confirmation)         *
SHIPPING ADDRESS IF DIFFERENT:    
   Company Name       
Address (We do not deliver to P.O. Boxes or Box Zip Codes)   Suite/Floor/Room   
City   Zip   State
        TransitChek is an IRS-approved commuter benefits program that lets employees save money on their commute by transit or eligible vanpools with tax-free dollars. They are eligible to use up to $230/month, tax-free. Please visit our website at: www.transitcenter.com for more information on using the TransitChek Program and other helpful information. ORDER INFORMATION
PRODUCT SELECTION CHART      
              ORDER INSTRUCTIONS   
             $30   $ $30 =    x                                                  
TransitChek    Card, a prepaid Visa ® ®                    (Not Returnable/ Not Refundable)                                card
FREE           (Limit one per employee) TransitChek Card User's Guides. Quantity:
                                                                                      
       © 2010 TransitCenter, Inc. All Rights Reserved COF-0310
         Denominations Quantity Cost/ Item Total Cost
                    $35 $ $35 = x                                                    
                                 $45 $ $45 = x                                        
                                           $50 $ $50 = x                                 
                                                  $55   $ $55 = x                            
                                                                                      $60 $ $60 = x                       
                                                                   $65 $ $65 = x                           
                                                                            $70 $ $70 = x           
                                                                                   $89 $ $89 = x      
                                                                           $ TransitChek Card Total                                       
                   4.5% Processing Fee ( $ .045 ) x                                                                       
                           $18.00 Packaging and Delivery                                                          
                                               Total Order Cost ( $ )                                    +     +  
          How frequently do you plan to order: Order Frequency:          
                 Chicago Metro    
Order Form
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Phone   Fax      
Email (Important: To receive order and shipping confirmation)        
                                                                                   $110 $ $110 = x      
                                                                                   $125 $ $125 = x      
                                                                                   $150 $ $150 = x      
                                                                                   $175 $ $175 = x      
                                                                                   $200 $ $200 = x      
Contact Name/Title          
* * Required fields
                                                                 TransitChek® Card, a prepaid Visa® card:      Can not be returned for credit or refund.    to make certain they are used before the expiration date. Cards have a one year expiration. Balances on TransitChek Cards that are near expiration or you suspect are damaged can be easily transferred to another TransitChek Card at www.transitcenter.com. Under Manage Your Account, click on TransitChek Card log-in. Please remind your employees to review their current and unused products
Are you a new customer?   
                                                                                   $230 $ $230 = x      
1. How to Order                     2. Payment Options   3. Shipments All products will be received 7-10 business days after receipt of payment.        "TransitCenter, Inc." Determine how many products you need to order per employee per benefit cycle. There is no minimum order.    Orders will not be processed until full payment is received. Please make checks payable to You may use a Certified Check, Bank Check, Money Order or Bank Transfer when placing your order. Sorry, no credit card orders at this time.        They will arrive in one box, via FedEx 2 Day service, and require a signature for delivery. 4. Fees Packaging and delivery fees for TransitChek orders are $18. Processing fees are 4.5% of your total order.
 
For questions about your order or assistance with ordering, call TransitCenter      Customer Service at: 1.800.945.CHEK (2435). Or visit us at www.transitcenter.com  
SEND FORM & PAYMENT TO:    
Standard Deliveries:   Overnight Deliveries:      JPMorgan Chase
TransitCenter, Inc. General Post Office PO Box 27457 New York, NY 10087-7457 Attn: Lockbox 27457 4 Chase Metro Tech Ctr, 7th Fl. East Brooklyn, NY 11245 1-800-945-CHEK (2435)
PRODUCT RETURN POLICY