First Name Last Name Primary or Best Phone Number Email Action Requested - Select -Link Smartcard to AccountUnlink Smartcard from AccountAdd Student (K-12), Senior, or Paratransit Fare to Smartcard or Mobile AppRemove Student (K-12), Senior, or Paratransit Fare from Smartcard or Mobile AppReport a Lost SmartcardOther Fieldset-LU Smartcard ID Number Ten characters, numeric only, do NOT include the 3-digit PIN. Account ID Starts with OH, and then 9 alphanumeric characters (A-Z, 2-7). The following digits are not used in the ID: 0,1,8,9. Smartcard-Identifying Name Please provide a descriptive "nickname", maximum 30 characters, that can used to uniquely identify this card-account relationship to you. Fieldset-AR Where is the change needed? Smartcard Mobile Ticketing App Fare Type Requested - Select -Student (K-12)Senior/DisabledParatransit Smartcard ID Number Ten characters, numeric only, do NOT include the 3-digit PIN. Account ID Starts with OH, and then 9 alphanumeric characters (A-Z, 2-7). The following digits are not used in the ID: 0,1,8,9. Paratransit ID # Your Paratransit ID is 2-7 digits long. Please submit a separate form for each location (Smartcard, Mobile Ticketing App) and fare type (Student, Senior, Paratransit) being requested. Fieldset-LO Date/Time of Occurrence Date/Time of Occurrence: Date Date/Time of Occurrence: Time Description of Issue Smartcard ID Number Account ID Starts with OH, and then 9 alphanumeric characters (A-Z, 2-7). The following digits are not used in the ID: 0,1,8,9. Protected by Spam Master
