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Print a Claim Form to Mail to Us with Your Metrocard

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Print a Claim Form to Mail to Us with Your Metrocard • Fair Fares Customers: How to file a MetroCard claim Call 311 directly. You can complete this form, but know that many claims can be filed online. Visit new.mta.info/farehelp. • EasyPay customers If you file a claim by mail, please remember to enclose (full or reduced fare) your original MetroCard Vending Machine receipt or call 1-877-323-7433. Select Bus Service MetroCard Fare Collector paper ticket along with your MetroCard. Reduced Fare • If your Reduced Fare MetroCard MetroCard customers are not required to mail their is lost or stolen go to www.new. card unless the card is damaged. Please keep copies mta.info/farehelp or call 511. for yourself. Damaged cards must be mailed Unlimited Ride MetroCard Customers We’re sorry to us; use this claim form. To receive credit for time remaining on your card, please complete this form and mail it to us. • If your 30-Day Unlimited or 7-Day Your envelope must be postmarked no later than you had a Express Bus Plus MetroCard one day after the problem occurs. Cards that are purchased at a vending machine damaged should be returned. MetroCard with a credit or debit card is MetroCard Vending Machine Customers lost or stolen, you have balance Charges for most credit and debit transactions are reversed within ten (10) business days. If corrections problem. protection; Call 511 or are not made to your incorrectly charged account 718-330-1234. by then, please file a claim. If a machine failed to add value to your card, you will need to mail us your All other customers We want to MetroCard. Reduced Fare MetroCard customers • Many claims can be filed online are not required to mail their card unless the card is resolve the at: new.mta.info/farehelp damaged. For your records • Or, you may print and complete Please make a copy of your completed claim form and issue. this form, and mail it to: any enclosures. MetroCard Customer We’re here to help Claims Center Call 511 (In New York State Only) or 718-330-1234 between 10 AM and 6 PM daily to speak to us. 130 Livingston St The cardholder assumes the risk of loss until the Brooklyn, NY 11201-9625 MetroCard, MetroCard Vending Machine Receipt or • You can also get this form and Select Bus Service (SBS) Receipt is received by the a postage-paid envelope at any MetroCard Customer Claims Center. Mail all correspondence to: 130 Livingston Street, ¯ station booth. Brooklyn, NY 11201-9625. • Go to section 5 for a MetroCard Vending Machine claim. Section 1 must be completed. • Go to section 6 for a Select Bus Service machine claim. 5. MetroCard Vending Machine Only Please use ink and print clearly. • Otherwise, complete sections 2, 3 and 4. Specify machine number hhhh 1. : q Mr. q Mrs. q Ms. Legal Name 2. MetroCard Enclosed (check all that apply) q EBT q Debit q Amex q Discover q MC q VISA q Pay-Per-Ride (Regular) q Single Ride Ticket Provide only first six and last four digits on your debit or hhhhhhhhhhhhhh credit card: q Reduced Fare First Unlimited Ride hhhhhhX X X X X X hhhh hhhhhhhhhhhhhh q 7-Day q 30-Day q 7-Day Express Bus Plus Last first six last four $ h hh hh Reference # on Receipt: hhhhhhhhhhhhhh Balance remaining . Street Address Date last used: hh/ hh/ hh hhhhhhhhhhhh m m d d y y Incident date: hh hh hh hhhh / / Time last used: h h : hhq am q pm m m d d y y Apt Incident time: h h : h h q am q pm hhhhhhhhhhhhhh 3. Where MetroCard was Purchased (check one) If cash was used: City q Station (name) ___________________________ Coins inserted: q $.05 q $.10 q $.25 q $1.00 Booth number hhhhh hh hhhhh– hhhh Bills inserted: q $1 q $5 q $10 q $20 q $50 State Zip Code (upper left corner of booth) q Neighborhood store _______________________ Total amount of claim $ h hh. hh hhhhhhhhhhhhhh Store Address____________________________ Please remember to include your original machine receipt. Country q MetroCard Vending Machine (MVM) q Receipt enclosed q Did not get one hhh– hhh– hhhh 6. q MetroCard Bus q MetroCard Van Select Bus Service Only Day Phone q Other __________________________________ Where did problem occur? Select Bus Service Route/Bus Stop/Cross Street: hhh– hhh– hhhh Evening Phone Date purchased: hh/ hh/ hh _________________________________________ m m d d y y hhhhhhhhhh MetroCard Fare Collector Time Purchased: h h : hhq am q pm 10-digit MetroCard serial number Specify Machine ID#: hhhhh (first set of numbers in upper left-hand corner on back of card under the word EXPIRES) 4. Description of the Problem (check one) Incident Date: hh/ hh/ hh m m d d y y d Subject to applicable tariffs and conditions of use. q “See Agent/Invalid Card” turnstile or farebox message EXPIRES Incident Time: h h : hhq am q pm xxxxxxxxxx q Damaged MetroCard For MetroCard Customer Service, call 511 or go to eFIX at mta.info q MetroCard purchase/refill problem Payment Type: (check one) q Card Expired q MetroCard q Single Ride Ticket Please continue by providing answers in the appliable q section(s). Please use this space for any additional details. q Free transfer problem Reduced Fare MetroCard q Extra fare(s) deducted _____________________________________________ Description of the Problem: (Check One) q Lost or stolen q Card was Captured/Not Returned _____________________________________________ q Extra Fare Charged q Transfer Problem _____________________________________________ Incident date: hh/ hh/ hh m m d d y y q Other ______________________________________ _____________________________________________ Incident time: h h : hhq am q pm Please remember to include your original machine receipt..
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