June 2015
FasTrak® Customer Service Center
PO Box 26926
San Francisco, CA 94126
www.bayareafastrak.org
1-877-BAY-TOLL (1-877-229-8655)
Fax: 1-415-974-6356
International: 1-415-486-8655
Account Application
1. Account Information Please Print or Type
Account Number __________________ or Tag Number _____________________________
First Name __________________________ Last Name ______________________________
Business Name (if any) ________________________________________________________
Mailing Address _____________________________________________________________
City _______________________________ State ________ Zip Code __________________
Day Phone _________________________ Evening Phone ___________________________
Email Address _______________________________________________________________
2. Tag Order Select Type and Number
Total # Toll Tags ______ Toll Tag ______
Used for traveling on
express lanes and bridges.
CAV Toll Tag ______
Eligible Clean Air Vehicles are required to use CAV
toll tags on SR-237 express lanes, a copy of your
DMV issued Decal certificate must be attached to
your application. See website for more info.
3. Account Payment Options Select a Payment Option
A refundable security deposit per tag is required for each toll tag. If you choose to the Credit Card Option, the
security deposit will be waived for the first three tags on the account.
Cash or Check Option
Add funds to your account using cash or checks.
Make check payable to BATA. Mail payment with this form to
the above address.
Do not send cash in the mail.
Call the CSC to receive
instructions on how to pay with cash.
Credit Card Option
Add funds to your account using a credit card.
Select One:
Visa MasterCard Discover American Express
Credit Card Number
Exp. Date (MMYY)
Signature (Required for Credit Card Payment)
4. Vehicle Information Add vehicles authorized to use your FasTrak account.
License Plate and State of Registration are required. You may back date the start date up to 90 days, but will be
assuming liability for any tolls or penalties associated with the vehicle during the effective time period.
Tags on account over 3
$20 each tag over 3
Total # tags
_______
$20 per tag
I authorize payment to my credit card for
the total amount due.
Total Now Due
Total Now Due
_______
_______
_______
_______
_______
click to sign
signature
click to edit
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