Read Microsoft Word - License Agreement_Page4_rev1003.doc text version

OKLAHOMA TURNPIKE AUTHORITY PIKEPASS LICENSE AND USE AGREEMENT

LICENSE: Subject to the terms of this License and Use Agreement ("Agreement"), the Oklahoma Turnpike Authority ("OTA" or "we" or "us") grants you a non-exclusive, revocable license to use the electronic toll payment Pikepass Tag ("Tag") on the Oklahoma Turnpike System ("Oklahoma Turnpikes"). Use, retention, or permitting others to use your Tag constitutes acknowledgement of and the equivalent of signing this Agreement. Each Tag is the property of OTA and shall be returned in the event the account holder closes their Pikepass account or at any time upon request by OTA. The intent of the Pikepass system is to provide efficient and convenient service on Oklahoma Turnpikes by allowing you to electronically pay tolls. MININUM PREPAID LICENSE AND TOLL FEE: The Minimum Prepaid License and Toll Fee is not a deposit. It is a Prepayment of tolls for use of Oklahoma Turnpikes. You agree to maintain the required Minimum Prepaid License and Toll Fee to cover all applicable toll charges, service fees, and penalties charged to your account. The applicable toll, established by OTA, is calculated at the entry/exit points and mainline/barrier plazas and deducted from your account each time your Tag is used on Oklahoma Turnpikes. You may obtain a current schedule of toll rates by contacting the Pikepass Customer Service Center or visiting our website. NEGATIVE OR SUSPENDED PIKEPASS ACCOUNTS: In the event your account balance becomes negative and remains negative for more than 30 days, the account will be suspended. Remove your Tag completely from your vehicle and pay cash for tolls to avoid any violations. A Tag in suspended status will not be valid on Oklahoma Turnpikes and will result in a violation if used. A violation may result in a "failure to pay" citation from the Oklahoma Highway Patrol and/or a civil penalty. In addition to the late payment fee, any tolls recorded by the system resulting from use of the Tag while the account is in suspended status will continue to accrue. To reactivate your account, you will be responsible for higher replenishment amounts. If you forget to take your Tag out of your vehicle when paying cash for tolls, you are required to provide receipts for those tolls paid by cash in order to receive credit for any tolls charged to your Tag. If your account is negative for more than 14 days, you will not receive applicable discounted Pikepass rates and will be charged the cash rate. LOST, STOLEN, OR DAMAGED PIKEPASS TAGS: If your Tag is lost or stolen, it is your responsibility to notify us immediately. Any use of the lost or stolen Tag will continue to be reflected on your account until the loss or theft is reported to us. We will deactivate your Tag upon notification and you will not be held responsible for future activity on the lost or stolen Tag. We will refund the Equipment Fee to your account if the Tag is recovered and is in good condition. Damage is defined as rendering the Tag defective or inoperable due to tampering, abuse, improper use, defacement, or accidental destruction. In the event a Tag is recovered, OTA reserves the right to apply toll charges to your account that were incurred while the Tag was lost or stolen. RECYCLING: Each Tag is operated by a battery and will require recycling near the end of the battery life (approximately five years). We will notify you by mail when it is time to recycle your Tag. Disregarding the notice to recycle within the time allotted may result in termination of this Agreement. It will result in the Tag being deactivated and possible fines for failure to pay tolls and/or violations. We will deduct a $30.00 Equipment Fee from your account for each Tag that is not returned for recycling as directed. TERMINATION OF LICENSE AND REFUNDS: OTA may terminate this Agreement at any time for any reason. You may terminate this Agreement at any time by making your request in writing and returning your assigned Tag(s) to the Pikepass Customer Service Center. Upon termination of the Agreement, we will refund any remaining balance after toll payments and any appropriate fees have been deducted, provided the Tag(s) is returned in good condition. We will apply any or all of the remaining funds in your account to the Equipment Fee in the event the Tag(s) is returned damaged. You remain responsible for all or any part of Equipment Fee and/or any other fees in excess of the remaining balance in your account. Any remaining balance in your account will be refunded in about 30 days after this Agreement is terminated and the account is closed. OTHER FEES: Service fees and other charges will be deducted from your account for additional services that are required to maintain the account. These fees are established by OTA and include, but are not limited to, the following: · Equipment Fee: $30.00/Tag- Deducted for each Tag issued to you, which is suspended, lost, stolen, damaged or otherwise not returned when requested by the OTA. Each Tag is and shall remain the property of OTA and must be returned to us. · Rejected Credit Card Charge Fee: $20.00- Deducted if the credit card company rejects your credit card charge. · Bank Draft (EFT) Refusal Fee: $20.00- Deducted if an authorized draft is not paid on demand by your bank. · Returned Check Fee: $20.00- Deducted if any check is returned for insufficient funds or stop payment. · Duplicate Statement Fee; $5.00/Statement- Deducted for a duplicate statement requested later than 30 days after the statement date. · Late Payment Fee: $10.00 or 2% of the outstanding balance, whichever is greater- Deducted if your account is negative for more than 30 days. In addition, your account will be suspended. Suspension of your account is grounds for termination of this Agreement. · Partial Payment Penalty Fee: $2.00/Tag- Deducted if you remit an amount less than the Minimum Prepaid License and Toll Fee. MISCELLANEOUS: · OTA is not liable for the performance of the Tag. You agree to indemnify OTA against all damage, loss, cost, expense or liability that in any way relates to the use or the performance of the Tag, including any System Match Transactions. You agree to pay all costs, including but not limited to, attorney's fees, court costs, etc., incurred by OTA to enforce the terms and conditions of this agreement. · OTA may alter, amend or otherwise change the terms and conditions of this Agreement at any time. If any part of this Agreement is invalid, all other parts remain in full force and effect. The laws of the State of Oklahoma govern this Agreement. · Certain Oklahoma Turnpikes require the Tag to be read by the Pikepass System at both the entry and exit location points to calculate the toll charge based on your actual travel. These turnpikes include the Turner, Will Rogers, Creek, Kilpatrick and Cherokee Turnpikes. If the Tag is not read at both the point of entry and point of exit on these turnpikes, the Pikepass system will complete the transaction utilizing the known read location(s) and will calculate the toll charge accordingly, up to and including the maximum toll for that turnpike based upon the classification of your vehicle as determined by the number of axles on the vehicle. These transactions (referred to as "System Matched Transactions") will be identified in your Statement of Toll Activity ("Statement"). You agree to this method of calculating toll charges. You further agree to review your Statement and notify the OTA of any toll charges inconsistent with the actual distance you traveled resulting from System Matched Transactions. OTA cannot determine whether any particular System Matched Transaction has resulted in toll charges inconsistent with your actual distance driven unless you review your statement and notify OTA; for this reason OTA relies on your efforts in this regard to help ensure you are not charged amounts inconsistent with the actual distance you traveled. · Information regarding possible errors, System Matched Transactions, or any other information about your account may be obtained by contacting the Pikepass Customer Service Center. Questions concerning your account statements should be received within 30 days of the Statement Delivery Date (defined as the 15th day of the month following the period displayed on the Statement). Requests after 30 days must be received in writing. Account adjustments may not be made for requests, including those relating to System Matched Transactions, received after 30 days. · If your account balance is ever insufficient to pay amounts owed to OTA, you will remain liable for those amounts and other applicable fees. · You must inform OTA immediately, in writing and/or by phone, of any changes to the information entered on your original application, i.e. address, phone number, vehicle description, credit card expiration, etc. Failure to do so may result in overcharges and/or penalties. · Tags may not work in all makes and models of vehicles. Contact the Pikepass Customer Service Center or visit our website for further information. · You will not receive interest on your Pikepass account. OTA reserves the right to offset for amounts owing to OTA from your account balance. · If you become the subject of any bankruptcy proceeding under the Bankruptcy Act or become insolvent, OTA has the right to terminate services provided and require all Tags be returned. You will remain liable for the payment of all unpaid charges exclusive of any other remedy provided by law. · Incomplete applications cannot be processed and will be returned to you. Tags must be mounted in accordance with the OTA guidelines previously provided. You may also obtain mounting guidelines appropriate for your vehicle by contacting the Pikepass Customer Service Center or our website. Failure to properly mount Tags may result in System Matched Transactions, citations and/or revocation of this license. OTA will not provide account adjustments for System Matched Transactions involving improperly mounted Tags. · This Agreement replaces and supersedes all previous agreements and is the sole instrument defining your relationship with OTA. If the terms of this Agreement are not acceptable to you, you should (1) discontinue use of your Pikepass Tag immediately; (2) return your Tag to OTA; and (3) close your Pikepass account. Any prepaid license and toll fee in your account will then be refunded to you. Use, retention, or permitting others to use your Tag after September 15, 2005 constitutes acceptance of these terms.

Form 1004.rev.1002.20070125.rm

COMPLETING THE APPLICATION

SECTION 1 - TYPE OF ACCOUNT AND NUMBER OF TAGS REQUESTED (Drivers License Required) Account Type: Please indicate the type of account you need. Write in the total number of Tags you want assigned to your account. 1) Commercial Accounts: To open a Commercial Account, the customer must provide copies of the following: a written authorization from the proper authority (someone who can assume liability for the company) on company letterhead, listing contact names and the company's Federal Tax ID Number. (Otherwise it will be opened as a commuter account.) A Minimum Prepaid License and Toll Fee of $80.00 is required to open this type of account. This entitles commercial customers up to three Tags initially. Additional Tags requested require a Minimum Prepaid License and Toll Fee of $80.00 per every three tags requested. 2) Commuter Accounts: The person who signs the application assumes financial liability for the Pikepass account. A Minimum Prepaid License and Toll Fee of $40.00 is required to open this type of account. This entitles commuter customers up to three Tags initially. Additional Tags requested require a Minimum Prepaid License and Toll Fee of $40.00 per every three tags requested. Accounts requesting 10 or more Tags will be opened as Commercial Accounts. 3) Government Accounts: Please call the Government Accounts Representative at the Pikepass Customer Service Center for further guidance. SECTION 2 - RESPONSIBLE PARTY INFORMATION Company Name: The Company's business name and Federal Tax ID number is required for Commercial Accounts. Application will be returned if not included. Name: Your complete legal name and drivers license number is required. Mailing Address: Your complete mailing address is required. Please include street designators (e.g. ST, AVE, RD. and APT #). Email Address: This is an option you choose for your statement and notice delivery method. Email is 5 days faster than regular mail. Phone Numbers: Provide a number you may be reached during the daytime and evening. A work phone number is required for Commercial Accounts. Account Access Code: Provide a four-(4) digit number to control and secure access to your account information and toll transactions. Changes to your Pikepass account, and/or any account information will only be provided to you (the individual account holder), or any person(s) you provide the Account Access Code. SECTION 3 - PAYMENT OPTIONS Method of Payment: Choose only one option. A credit/debit card, voided check, or cash deposit is required to open an account. If you apply for a Pikepass Account, in person, at one of our designated Customer Service Agents or by facsimile, your initial Minimum Prepaid License and Toll Fee must be made by credit/debit card. If you apply for a Pikepass account by mail and you request a payment option other than Credit Card (Auto Charge), you must enclose a check or money order for your initial Minimum Prepaid License and Toll Fee. A credit card or cash deposit ($30.00 per Tag requested) must be provided to secure all Cash/Check/Money Order (Manual Replenishment) accounts. Failure to maintain the credit card security or cash deposit on all Cash/Check/Money Order accounts will result in termination of the License Agreement. 1) Credit Card Payment (Auto Charge): If you would like your credit/debit card automatically charged, mark the Credit Card (Auto Charge) box on the application. Include your credit card number and expiration date. Please write your name and sign as it appears on the credit card. Credit Card Accounts will be replenished automatically by charging your authorized credit card when your Pikepass account reaches a balance of $10.00 for Commuter accounts or 1/3 of the Minimum Prepaid License and Toll Fee for Commercial Accounts. 2) Direct Debit Bank Draft/EFT (Auto Charge): If you would like your bank account debited directly, mark the Direct Debit Bank Draft/EFT box on the application. You must complete the Direct Debit Bank Draft Information, including Bank Name, Address, Phone #, Account #, and Transit/ABA#. Bank Draft Accounts will be replenished automatically by debiting your designated bank account when your Pikepass account reaches a balance of $10.00 for Commuter accounts or 1/3 of the Minimum Prepaid License and Toll Fee for Commercial Accounts. 3) Cash/Check/Money Order (Manual Replenishment): If you would like to be billed when your account falls below a certain amount, mark the Cash/Check/Money Order box on the application. A credit/debit card or cash deposit ($30.00 per Tag requested) must be provided to secure all Cash/Check/Money Order accounts. The security credit/debit card is only charged when your account is overdrawn for more than 30 days, immediately prior to your account being suspended. If you keep your account in good standing, we will not charge your security credit/debit card. Please write your name and sign as it appears on the credit/debit card. Cash/Check/Money Order accounts will receive a "Payment Request" when the account reaches a balance of $15.00 for Commuter accounts or 1/3 of the Minimum Prepaid License and Toll Fee for Commercial Accounts. You are required to replenish your Cash/Check/Money Order account by remitting the amount requested. Payments must be received before your account balance reaches zero. SECTION 4 - ITEMIZED STATEMENT OF TOLL USAGE Statement Frequency: Pikepass Account Statements are mailed to you either quarterly or monthly, depending upon which option you choose. If you don't choose a statement frequency option, we will mail your statements quarterly. These statements detail all account transactions as well as toll usage. If you do not have activity on your account, we will not send a statement. Duplicate statements, if requested within 30 days from your last statement, are available free of charge. A duplicate statement requested later than 30 days after the statement date cost $5.00 per statement. SECTION 5 - VEHICLE INFORMATION Detailed Vehicle Information: To help eliminate billing errors and possible toll violations, this section must be completed carefully. Verify your license plate number and vehicle axle counts before the application is processed. You must list anything that may be towed, including boats, trailers and cars. These may affect vehicle classification. Vehicle descriptions are required for each Tag issued. You must have a license plate number for each vehicle listed. If you do not have a license plate number, a Pikepass Tag cannot be issued. SECTION 6 - READ AND SIGN Signature: By signing the application you assume financial responsibility for the Pikepass Account, Pikepass Tag(s), and all related tolls and charges. The signature must be dated.

PIKEPASS Customer Service Center Nationwide Toll Free (800) 745-3727 MAILING ADDRESS: PIKEPASS Customer Service Center, 4401 West Memorial Road, Suite 130, Oklahoma City, OK 73134-1722

Form 1004.rev.1005.20070313.rm

(Please print using black ink. Incomplete applications cannot be processed and will be returned.) SECTION 1 - TYPE OF ACCOUNT Personal Commercial Government (See Agreement)

(Please Print)

*** OTA PIKEPASS APPLICATION ***

NUMBER OF TAGS REQUESTED:

SECTION 2 - RESPONSIBLE PARTY INFORMATION

Company Name (If Commercial Account) _________________________________________________________ Fed Tax ID # ___________________________ First Name _________________________________ Last Name_______________________________ MI_____ Driver License #______________________ Mailing Address _____________________________________________________City __________________________State _______Zip ______________ E-mail:_____________________________________________Daytime Phone (_____)__________________ Evening Phone (_____)__________________ Account Access Code (You must provide a 4 digit # for account access security): SECTION 3 - PAYMENT OPTIONS (Choose Only One) - (Your initial payment and Credit Card or Voided Check is required.) CREDIT/DEBIT CARD (Auto Charge): _____Visa _____MasterCard _____Discover _____American Express Cardholders Name

(as it appears on card):

_______________________________________Cardholders Signature_______________________________

Card Number: __________________________________________________ Expiration Date: ________/________ By signing, you agree the OTA has authorization to automatically charge your credit/debit card for the Minimum Prepaid License and Toll Fee as necessary. This authorization will remain in effect until OTA has received notice of its termination and has a reasonable opportunity to act upon it. DIRECT DEBIT BANK DRAFT (Auto Charge): OTA has authorization to automatically charge my account for the Minimum Prepaid License and Toll Fee as necessary at the bank indicated below. This authorization will remain in effect until OTA has received written notice of its termination and has a reasonable opportunity to act upon it. A voided check MUST be attached. The bank accountholder must sign the application below. Bank Name __________________________________ Address _____________________________________ Phone Number (_____) ______________ Account Number ____________________________________ Transit/ABA # __________________________________________________ CASH / CHECK / MONEY ORDER: A credit/debit card or $30 cash security deposit, per Tag, is required to secure cash accounts. If my account becomes overdrawn for more than 30 days, I authorize the following credit card to be automatically debited for the delinquent account balance and Minimum Prepaid License and Toll Fee. Cardholders Name (as it appears on card): _________________________________________Cardholders Signature________________________________ Type of Card: __________________________ Card Number: ________________________________________________ Exp. Date: _______/________ SECTION 4 - ITEMIZED STATEMENT OF TOLL USAGE

FREQUENCY (CHOOSE ONE) DELIVERY METHOD (CHOOSE ONE)

Quarterly

Monthly

Regular Mail

E-Mail

(Include Email address in Section 2.)

SECTION 5 - REQUIRED VEHICLE INFORMATION *License Plate and Vehicle Description is Required* Count total of all vehicle axles, including trailer combinations. (i.e. car or motorcycle = 2 axles; trailer = 1 axle; car and trailer = 3 axles)

License Plate State Plate # Year Make Vehicle Model / Unit # # Axles Office Use Only PIKEPASS # Class

(Please list additional vehicles on separate sheet of paper with the above information and attach to this application.) SECTION 6 - READ AND SIGN By signing below, I acknowledge the contents of this License and Use Agreement and agree to comply with its terms and conditions. I have checked one of the payment options above and listed my credit card or my checking account number. I hereby authorize the OTA to charge my credit/debit card or checking account indicated for the amount necessary to satisfy my obligations under this License and Use Agreement. ________________________________________________ Responsible Party Signature

FOR OFFICE USE ONLY

______________________________ Title (Commercial Accounts Only)

_____________________________ Date Signed

DATE _______/________/_______ CSR ID ____________________

No. of Tags Assigned: ________________ CC Authorization No ____________________________________Account No.: __________________________________________

Form 6003.rev1007.20070511.rm

REMEMBER to Enclose...

The Completed Application A copy of your valid Drivers License Valid Credit Card Info or Voided Check Initial Minimum Pre-Paid License and Toll Fee License Plate Number on the Application Commercial Accounts- Letter and Federal Tax ID #

FOR A CUSTOMER SERVICE AGENT NEAR YOU: Nationwide Toll Free (800) 745-3727 Or visit www.pikepass.com MAILING ADDRESS: PIKEPASS Customer Service Center 4401 West Memorial Road, Suite 130 Oklahoma City, OK 73134-1722 FAX: Oklahoma City (405) 751-5248 or Tulsa (918) 445-7294

Form 1004.rev1003.20060802.rm

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