ORCA Card Order/Add Value Form
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ORCA Card Order/Add Value Form Order a new ORCA card with or without value, add value to a current ORCA card, or replace an adult, low income (LIFT), youth or senior ORCA card. Complete and submit this form with card fee and add value payment. NOTE: There is no fee for your first reduced fare card. For a new or replacement youth ORCA card (6-18 years) or senior Regional Reduced Fare Permit (RRFP) ORCA card (65+ years), enclose proof of age (student ID, state ID or birth certificate). A disabled RRFP requires a photo and is only issued in-person at an ORCA customer service office or at kingcounty.gov/reducedfare. STEP 1 - Order Card or Add Value (Please print and use black or blue ink.) Check all that apply: I need a new adult ORCA card. I need a new senior RRFP or youth ORCA card. Birth date: ___/___/___. Attach a copy of student ID, state ID or birth certificate. I need a replacement senior RRFP or youth ORCA card. Birth date: ___/___/___. Attach a copy of student ID, state ID or birth certificate. Enter ORCA card serial number: ___/___/___/___/___/___/___/___. (Eight digits on front left corner of card). I need a replacement adult ORCA card or a low income ORCA LIFT card. Enter ORCA card serial number: ___/___/___/___/___/___/___/___. (Eight digits on front left corner of card). I have an ORCA card and want to add value. Enter ORCA card serial number: ___/___/___/___/___/___/___/___. (Eight digits on front left corner of card). STEP 2 - Select Your Value Check the box and include the fee for a new or replacement ORCA card. To add E-purse value, write in the E-purse amount. To add a pass, check the box by the Regional or Agency pass and the applicable calendar month (on page 2). Allow up to 10 business days to load value onto your current ORCA card. Add $5 fee for each new and/or replacement adult ORCA card. A. Adult new and/or replacement card fee $ ______________ Add $5 fee for each replacement youth ORCA card. B. Youth replacement card fee $ ________________________ Add $3 for each replacement senior RRFP, or low income C. Senior RRFP or ORCA LIFT replacement fee $____________ ORCA LIFT card. Add E-purse* (Write in whole dollar amounts. Example: $50). D. Total E-purse $ ___________________________________ *E-purse is not valid on Vanpool or King County Metro Access vans. (Minimum is $5; maximum is $300) Add Regional Pass (PugetPass) Check the box of the Regional Pass you want to add to your ORCA card. Record the total below (E). Regional Monthly Pass Purchase Price Regional Day Pass Purchase Price $0.50 PugetPass $18 $3.50 Regional All Day Pass $8 $0.75 PugetPass $27 $1.75 Regional All Day Pass – Reduced Fare* $4 $1.00 PugetPass $36 * Requires a RRFP, youth or low income ORCA LIFT card. $1.25 PugetPass $45 $1.50 PugetPass $54 $1.75 PugetPass $63 Regional Day Pass Quantity _________________________ $2.00 PugetPass $72 (Maximum of 12) $2.25 PugetPass $81 Regional Day Pass Subtotal $ ________________________ $2.50 PugetPass $90 (Multiple quantity x price) $2.75 PugetPass $99 Regional Monthly Pass Quantity _____________________ $3.00 PugetPass $108 (Maximum one per calendar month) $3.25 PugetPass $117 $3.50 PugetPass $126 Regional Monthly Pass Subtotal $ ____________________ $3.75 PugetPass $135 (Multiple quantity x price) $4.00 PugetPass $144 $4.25 PugetPass $153 $4.50 PugetPass $162 $4.75 PugetPass $171 $5.00 PugetPass $180 $5.25 PugetPass $189 $5.50 PugetPass $198 $5.75 PugetPass $207 $10.00 PugetPass $360 E. Total Regional Pass $ ____________________________ 10-01-2021 orcacard.com 1 Add Agency Pass – Check the box of the agency product you want to add to your ORCA card. Record the total below (F). Agency Passes Purchase Price Kitsap Transit Full Fare Pass $50.00 Kitsap Transit Reduced Fare Pass* $25.00 * Requires a Regional Reduced Fare Permit (RRFP), youth, or low Income ORCA LIFT card. Kitsap Transit Worker/Driver Full Fare Pass $97.00 ** Requires King County Metro Access ID. Valid on Sound Transit’s ST Express bus, Link light rail, and Sounder trains. Not available for Business Accounts. Kitsap Transit Reduced Fast Ferry Only Pass* $84.00 Kitsap Transit Fast Ferry Only Pass $168.00 *** For registered Pierce Transit SHUTTLE passengers. Also valid on Pierce Transit buses. Requires a RRFP or youth ORCA card. Kitsap Transit Bus/Fast Ferry Pass $196.00 **** Valid on Pierce Transit buses. Not valid on Pierce Transit SHUTTLE services. No transfer Kitsap Transit Reduced Bus/Fast Ferry Pass* $98.00 value on other agencies’ services. Metro Monthly Access Pass** $63.00 † Monthly passes provide 31 rides in a specified calendar month on the specified route. WSF passes are valid for passenger-only travel and cannot be added to youth or RRFP Metro Monthly Vanpool/Transit Pass $99.00 ORCA cards. Pierce Transit All Day Pass – Adult $5.00 Pierce Transit All Day Pass – Reduced* $2.50 ‡ WSF Multi-ride tickets provide 10 rides. Valid for passenger-only travel 90 days from date of purchase on specified route. Pierce Transit Summer Youth Pass (Valid 6/1-8/31)* $36.00 (1) WSF Vashon Island = Fauntleroy/Vashon, Southworth/Vashon, & Pt Defiance/Tahlequah. Pierce Transit Reduced Fare Adult Monthly Pass*** $63.00 (2) WSF Central Sound = Seattle/Bainbridge/Bremerton & Edmonds/Kingston. Pierce Transit Adult Monthly Pass**** $62.00 Washington State Ferries Purchase Price Routes Monthly Pass† Multi-ride‡ WSF Mukilteo-Clinton $73.95 $46.20 WSF Vashon Island (1) $79.70 $49.80 WSF Fauntleroy Southworth $93.80 $58.60 WSF Port Townsend-Coupeville $101.80 $63.60 WSF Central Sound (2) $120.00 $75.00 WSF Anacortes-San Juan Islands N/A $98.30 F. Total Agency Pass $ _______________________ Select Month Check only one month for each pass you are ordering. The current month’s pass is not available for purchase after the 14th of the month. January April July October February May August November March June September December STEP 3 - Submit Payment Add up the total of A + B + C + D + E + F and write on the Total Due (G) line: G. Total Due $ _______________________________ Indicate method of payment for the Total Due (G): Enclose a check or money order payable to King County Metro – do not enclose cash. Visa MasterCard *Credit Card Number: *Three digit CVV (Credit Validation Value) from back of credit card: *Expiration Date (MM/YY): ___________/___________ *Name on Credit Card: ______________________________________________________________________________________ *Billing Address: ____________________________________________________________ Apt. Number: ____________________ *City: ________________________________________________________ *State: _____________ *Zip: ___________________ *indicates required field For Credit Card orders only: I authorize the ORCA Agent to charge the authorized credit card account for the amount indicated. Signature: ______________________________________________________ Date: __________________________ 10-01-2021 orcacard.com 2 STEP 4 – Provide Contact Information Your new ORCA card will be mailed to the person and address you indicate below: Same as above Credit Card Billing Address First Name: ___________________________________________ Last Name: ______________________________________________ Mailing Address: __________________________________________________________ Apt. Number: ________________________ City: ________________________________________________________ State: ______________ Zip: _______________________ Please provide a daytime phone or email in case we have a question about your order. Daytime Phone: _______________________________________ E-mail: _____________________________________________________ If the total value of your order is $200 or more, your new ORCA card will be mailed certified. Someone must sign for the envelope when it is delivered to the mailing address you have indicated above. Check here to have your new card registered with this contact information. Note: Senior RRFP cards are registered when issued. (See the ORCA Terms of Use for details.) STEP 5 – Submit Order Form If this order includes a pass product, your completed order form must reach the ORCA Regional Mail Center by the 20th of the current month to ensure you can use your card by the first of the next month. If this order includes a new or replacement youth ORCA card (6-18 years) or senior RRFP ORCA card (65+ years), please attach a copy of student ID, state ID or birth certificate to verify age. Verification will be returned with the new ORCA card. Mail completed form to: ORCA Regional Mail Center KSC-TR-0108 201 S Jackson St Seattle WA 98104-3856 Check here to receive a copy of the ORCA Terms of Use. Check here to receive a copy of the ORCA Privacy Statement. To ensure your transportation fare is activated, you must tap your ORCA card within 60 days of purchase. Prices are subject to change. Questions: If you have a question about ORCA products, Autoload or card registration, visit orcacard.com or call ORCA Customer Service at 888-988-6722 / TTY: 711, during regular business hours. For non-English interpreter service, call 800-823-9230. Alternate formats are available. 10-01-2021 orcacard.com 3 .