Creating a Service Agreement

If you have chosen the Comprehensive service option, simply fill out this form to create a Service Agreement. If you have selected Enrollment Support, Distribution Support, or need further assistance, please email TransitChek Select or call 215-592-1800.

Upon completion of the form, a customized pdf incorporating your information will be created for you to print out. Simultaneously, a copy of the pdf will be sent to our office. We will then send to you via surface mail two copies of the agreement signed by us for you to countersign. If you have any question about the process or agreement, please call 215-592-1800.

1.	Company Name:
2.	Address:
	City, State Zip:
3.	Address to Invoice (if different):
	City, State Zip:
4.	Authorized Contact Person:
	Phone:
	Fax:
	E-mail:
5.	Alternate Contact Person:
	Alternate Phone:
	Alternate Fax:
	Alternate E-mail:

6.	Would you like monthly or quarterly distributions to your employees?

Monthly-based plan with variable fee. Flat fee of $3.25 per person per month plus 2% of the face value of TransitChek vouchers

7.	How many employees do you anticipate signing up?

		Fewer than 500 ($250 set-up fee)
		500-1,000 ($500 set-up fee)
		more than 1,000 ($750 set-up fee)