Spectrumotion- Personal Commuting Services

*Unless noted otherwise, all fields are required.*

Date (mm/dd/yyyy)	/ /

Personal Information
First Name
Last Name
Home Address
City
Zip Code
Major Cross Streets	&
CA Driver's License Number	(required for delivery verification)

Employment Information
Employer Name
Work Address
City
Zip Code
Work Phone	- - Ext.
Fax	- - (optional)
E-mail
HR Rep/Supervisor Name
Work Hours	am to pm

Please acknowledge the rules and requirements below by placing a check in each of the boxes
I acknowledge that the above is true and correct. I have read and understand the eligibility requirements. I agree to notify Spectrumotion immediately should any of the above information change. I further acknowledge that I am currently driving alone to work, have not been ridesharing for the past 90 days and am a first time OCTA bus rider. I understand that if I am found to have falsified any of this information, I will become ineligible to participate in any of Spectrumotion's subsidy programs, promotions and the Emergency Ride Home program. I understand that I am required to participate in the follow-up survey. If I don't participate I will pay Spectrumotion for the total amount of the pass. I understand that I am to return an unused pass to Spectrumotion. If I do not return the unused pass, I will pay Spectrumotion for the total amount of the pass.

OCTA Bus Passes
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