Toll Tag Request

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
Toll TagApplication
Request
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
Standard ______
Exterior ______
FasTrak Flex ______
Standard tags are the most
popular tag for use at all toll
bridges, solo drivers in express
lanes, and at parking garages.
Exterior tags are mounted to
the vehicle’s license plate.
FasTrak Flex is the
express lane carpool tag.
Total # tags ______
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
Exp. Date (MMYY)
Credit Card Number
Total # tags
$20 per tag
_______
Total Now Due
_______
Tags on account over 3
$20 each tag over 3
_______
_______
Total Now Due
_______
_______
I authorize payment to my credit card for
the total amount due.
1
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.
License Plate
State
Make
Model
Year
Effective Start Date
June 2015