| Please
ensure that all sections of the application have been completed. |
| 1.
TYPE OF APPLICATION |
ENROLMENT or
RENEWAL (if you were already enrolled in the FIDÉLITÉ Program)
(Complete sections 2, 3, 4 and 5)
|
| 2.
MEMBER INFORMATION |
Last
Name
:
First Name:
Gender :
Year of birth:
My Passe-Partout Plus card no.:
(YYYY)
or
No card
(6 digits under the photo)
RESIDENTIAL ADDRESS
Number :
Street :
Apt. No. :
City :
Postal Code :
E-mail :
Home Telephone: (
)
-
Work Telephone: (
)
-
Extension
|
|
|
| 3.
TYPE OF PASS |
ADULT REGULAR
ADULT EXPRESS
ADULT INTERZONE
SENIOR (Proof of age required.)
A fare schedule is available at sto.ca.
|
Please indicate the desired start date of the pass : |
|
|
|
Month
(MM) |
Year
(YYYY) |
Please indicate the Service Point where you wish to pick up the Passe-Partout
Plus pass:
Please
allow 15 days for the application to be processed. After the 25th
of the month, you can go to the Service Point selected to exchange
your annual Passe-Partout Plus pass for the new Passe-Partout
Plus pass requested.
|
| 4.
MEMBER STATEMENT |
-
I certify the accuracy of the information provided on this enrolment
/ renewal form.
-
I
have read the FIDÉLITÉ Program terms and conditions
posted at sto.ca (general terms and conditions, renewal method,
cancellation terms and conditions, pass type modification, change
in financial institution, moving, miscellaneous, STO pass on the
OC Transpo system) and I agree to comply with all of the provisions.
-
I
authorize my financial institution to process a debit on my account
for all amounts ordered by the Société de transport
de l’Outaouais, for as long as my pass remains active.
-
Bank
account debits will be taken on the 25th day of every month or the
next business day, and each debit equals 90% of the full fare for
a monthly pass of the same type.
-
I
agree to waive the pre-notification requirements of the Canadian
Payments Association of the amount(s) and due date(s) debited from
my account and every time there is a change in the amount(s) or
payment date(s) of those debits.
-
Enrolment
in the FIDÉLITÉ Program is annual and the pass is
renewed automatically unless a cancellation form, available
on the STO’s Web site at sto.ca, is duly completed and submitted
to the Finance Department at the STO at least 10 business days before
the next scheduled debit date. For more information on my rights
to cancel a PAD (pre-authorized debit) Agreement, I can contact
my financial institution or visit www.cdnpay.ca.
-
I
have certain rights of recourse if a debit is not in accordance
with this agreement. For example, I have the right to receive a
reimbursement for any PAD that is not authorized or is not compatible
with this PAD Agreement. For more information on my rights of recourse,
I can contact my financial institution or visit www.cdnpay.ca.
I have read and agree to the terms and conditions mentioned above.
|
| 5.
MEMBER AUTHORIZATION |
|
|
I
am including a sample cheque marked VOID for the account to be debited. |
| |
Member Signature
|
Account Holder Signature (if different) |
Date (YY/MM/DD)
|
To have the enrolment or renewal request processed, please send
this duly completed and signed form, with a sample cheque marked
VOID, by mail to 111 Jean-Proulx, Finance Department, Gatineau,
Quebec, J8Z 1T4, by fax to 819 770-5987, by e-mail to fidelite@sto.ca.
or dropped off at one of the STO Service Points (Galeries Aylmer,
Les Promenades or STO administration office). Please print the
form on legal size paper. For
more information, visit sto.ca, write to fidelite@sto.ca or call
819 770-3242. |
|