E Zpass Ma Application Template

E Zpass Ma Application Template

The E-ZPass MA Application form is a crucial document for individuals seeking to establish an electronic toll collection account in Massachusetts. This application enables users to access the benefits of the E-ZPass system, allowing for seamless travel through tolls without the need for cash transactions. To begin the process, interested individuals can fill out the form by clicking the button below.

Table of Contents

The E-ZPass MA Application form is essential for individuals looking to establish an E-ZPass account in Massachusetts. This form is specifically designed for owners or lessees of 2-axle and 4-tire vehicles, ensuring that users can easily navigate the toll system. When filling out the application, personal information such as name, address, and contact details must be provided clearly. Additionally, applicants need to list all vehicles that will utilize the E-ZPass transponders, ensuring compliance with the system's requirements. The form also includes sections for selecting payment options, whether through direct debit from a checking account, a credit or debit card, or manual replenishment. It's important to note that each account can request a maximum of four transponders. A personal identification number (PIN) is required for account access, enhancing security. Applicants must also acknowledge and accept the terms and conditions set forth by the Massachusetts Department of Transportation (MassDOT), which govern the use of the E-ZPass system. Understanding these components is crucial for a smooth application process and ongoing use of the E-ZPass service.

E Zpass Ma Application Sample

®

www.mass.gov/ezpassma

1-877-627-7745

APPLICATION FOR INDIVIDUAL E-ZPASS MASSACHUSETTS ACCOUNT

Please note, this Application is for privately owned or leased 2-axle,

Mail or Fax application to:

E-ZPass MA Customer Service Center

4-tire vehicles only. Operators of vehicles with more than 4 tires, or

27 Midstate Drive

vehicles with livery, taxi, combination (plates) or other commercial license

Auburn, Massachusetts 01501-1839

plates should call toll-free 1-877-627-7745, Option 3, then Option 7, to

FAX: 1-508-786-5222

receive a Commercial Business Account Application.

To join online visit www.mass.gov/ezpassma

PLEASE PRINT CLEARLY

Personal

Information

Statement

Options

(check only one)

Vehicle

Information

IMPORTANT

As it appears on your vehicle registration

REQUIRED - 4 DIGIT PERSONAL PIN NUMBER

 

 

 

 

 

 

 

 

 

IMPORTANT

 

 

AUTHORIZED ALTERNATIVE CONTACT

 

 

 

 

 

 

 

 

 

 

(Select any 4 numbers to access your account information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

online or over the phone)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LAST NAME

 

 

 

 

 

FIRST NAME

 

 

 

 

MI

 

 

EMAIL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

STATE

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOME PHONE

 

WORK PHONE

 

 

 

CELL PHONE

 

 

 

 

 

 

FAX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please do not send a monthly account

 

 

Please e-mail a link to my monthly account

Please mail a monthly account statement to the address listed above.

statement; I can use the on-line Account

 

 

statement each month. I have provided my

I understand that there is a $2.00 monthly fee for this service and

Manager to access my statement.

 

 

e-mail address above.

 

 

 

 

 

I authorize E-ZPass MA to deduct this fee from my E-ZPass MA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

account each month.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List all vehicles that will be using your E-ZPass MA transponders.

 

 

 

 

 

 

Reminder Please remember to always update your account with any

Please note that you must list at least one vehicle for each transponder requested.

 

 

 

 

changes or additions to vehicle(s) or personal information.

LICENSE PLATE NO.

PLATE TYPE

 

STATE

 

 

 

 

 

MAKE & MODEL OF VEHICLE

 

 

 

 

 

YEAR

INDICATE IF LEASED VEHICLE

(Reference Vehicle Registration)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Transponder(s)

Please indicate the number of transponders you are requesting.

 

 

(Maximum 4 transponder(s) per account)

TRANSPONDERS REQUESTED

Toll Payment Options (check only one)

OPTION B Direct Payment from Checking Account

By Choosing Option B: You hereby authorize E-ZPass MA to initiate debit entries from your checking account to automatically replenish your E-ZPass MA account whenever the account balance falls below the Low Balance threshold. This authorization is to remain in full force and effect until E-ZPass MA has received written notification of its termination in such time and in such manner as to afford E-ZPass MA reasonable opportunity to act on it.

OPTION B

$ 20

OPENING ACCOUNT BALANCE

Checking Account Routing NumberChecking Account Number (If easier attach a voided check from your checking account)

OPTION C Direct Payment from Credit/Debit Card

By Choosing Option C: You hereby authorize E-ZPass MA to initiate debit entries from your credit/debit card listed below to automatically replenish your account whenever the account balance falls below the Low Balance threshold. This authorization is to remain in full force and effect until E-ZPass MA has received written notification of its termination in such time and in such manner as to afford E-ZPass MA reason- able opportunity to act on it.

 

PLEASE CHECK ONE:

MC

VISA

DISC

AMEX

 

 

 

Credit/Debit Card Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EXPIRATION (Month/Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OPTION D Manual Account Replenishment (If mailing application, please include initial payment)

 

 

Customers Choosing Option D are required to maintain a sufficient pre-paid balance in their account. At some locations, you will see a yellow

 

 

“Low Balance” light in the designated lane when your E-ZPass MA account balance falls below the low balance threshold; this yellow “Low

 

 

Balance” light indicates that you will need to replenish your account by mailing a check or making a payment at one of the E-ZPass MA Customer

 

 

Service Centers. If your account falls below $0.00 you will be issued a toll violation. A Pay-By-Plate MA invoice will be issued for travel on

 

 

the Tobin Bridge. Cash Payments: Cash preferred customers can replenish their E-ZPass MA accounts using self-service kiosks with cashier

 

 

assistance at retail cash payment locations. A convenience fee for each E-ZPass payment will be charged.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Authorization

I have read the information on this application, including the terms and conditions. I authorize payment as

 

 

selected, and certify that all information contained in the application is true and accurate.

 

IMPORTANT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CUSTOMER SIGNATURE REQUIRED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOW E-ZPASS WORKS

E-ZPass provides customers with electronic toll collection through the use of a transponder. As you pass through a designated E-ZPass lane, the transponder is read, a green “Thank You” light is flashed, and your toll transactions are recorded in your E-ZPass account.

OPTION C

$ 20

OPENING ACCOUNT BALANCE

OPTION D

$ 20

OPENING ACCOUNT BALANCE

 

Clerk ID

❏ Gift Certificate

 

❏ Cash

$:

Acct#:

 

 

 

E-ZPass MA use

 

 

 

 

 

 

 

ACH-Prepaid

❏ Credit Card

❏ Check

 

 

Date

 

Tag#

 

 

 

 

 

 

 

 

only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

03/2015

The Massachusetts Department of Transportation (“MassDOT”) establishes these terms and conditions that govern the use of the Electronic Toll Collection (“ETC”) E-ZPass system and require that account holders/customers accept these terms and conditions.

Use of the E-ZPass system is limited to customers who join the E-ZPass program and maintain their account in good standing. An E-ZPass customer in “good standing” means a customer who: (1) submitted a completed E-ZPass application to MassDOT’s E-ZPass MA Customer Service Center; (2) affixed the transponder(s) in accordance with the instructions provided; (3) maintains their account current, with sufficient balance at all times to pay for all E-ZPass transactions; and (4) uses the E-ZPass system in accordance with the E-ZPass Program Agreement and MassDOT’s regulations.

The following terms and conditions supersede any terms and conditions you may have previously received. These terms and conditions, together with your application, constitute the E-ZPass Program Agreement. Please read all of the terms and conditions and the entire application prior to using an E-ZPass transponder. When a transponder assigned to you is used, you agree as follows:

1. TERMS

a)MassDOT may, at any time, suspend or terminate your E-ZPass account, and/or electronically deactivate your E-ZPass transponder(s) for violation of applicable laws, regulations, or the terms and conditions of the E-ZPass Program Agreement. You shall remain and be liable for payment of all fines, penalties, costs, fees, and any other monies owed pursuant to the terms of this agreement and any applicable law.

b)MassDOT reserves the right to reject any E-ZPass application.

c)If any of the terms of this agreement are declared or found to be illegal, unenforceable or void, then MassDOT and

the E-ZPass customer shall be relieved of all obligations under that term. The remainder of the agreement shall be enforced to the fullest extent permitted by law.

2. TRANSPONDER USAGE

a)You agree that the E-ZPass transponder(s) remains the property of MassDOT. This is required for manufacturer warranty purposes, and to establish a mechanism for the proper disposal of an inoperable transponder once you return it to MassDOT.

b)You agree to affix the E-ZPass transponder(s) in the vehicle(s) in accordance with the instructions provided and to use the transponder(s) only in the vehicles that you have listed on your application, and updated as neces- sary. Failure to do so may subject you to a Violation Fine, a Video-Toll (“V-Toll”) Administrative Fee, or an invoice from the Pay By Plate (“PBP”) All Electronic Toll (AET) system at the PBP toll rate that is established by MassDOT.

c)You agree that you may not use any designated E-ZPass lane unless the vehicle is properly equipped with an E-ZPass transponder and that vehicle has been listed on or added to your account.

d)You acknowledge that you are required to enter and exit all toll plazas through a designated E-ZPass lane. Oth- erwise, you will be required to pay your toll in cash at a designated cash toll booth, except if the vehicle is a Two Axle Commercial Vehicle. Two Axle Commercial vehicles are required to have a transponder and use a designated E-ZPass lane in accordance with 700 CMR 7.03(9) and these Terms and Conditions.

e)When traveling on the Massachusetts Turnpike’s ticket system (interchanges west of Route 128/I-95) and a point of exit, but no point of entry, is registered for the E-ZPass transaction, or upon the posting of a V-Toll at point of exit, you agree that the E-ZPass system will use the entry point that is farthest from the point of exit when calculating the toll amount. You may only contest the toll amount in writing to the Customer Service Center in accordance with Section 6 below. If the toll is reduced, your E-ZPass account will be credited the amount of the reduced toll.

f)You agree that you will comply with the posted speed limit. You are advised and you agree that exceeding the posted speed limit will subject you to fines and penalties and/or termination of your E-ZPass account.

g)You agree to obey all applicable federal and state laws and regulations governing the use and operation of Mass- DOT’s facilities and the E-ZPass Program. Failure to do so may result in fines and penalties and/or termination of your E-ZPass account.

h)You agree to pay all costs associated with the use of the E-ZPass transponder(s) assigned to you.

i)You agree to obey all signage, postings and signal messages in the E-ZPass lanes. You agree that you will not use the E-ZPass lane after you have received a message in the lane to “CALL E-ZPass” (signifying that a violation has occurred) until you have contacted the Customer Service Center and verified that your E-ZPass account is in good standing. Failure to do so may result in additional costs, fines and penalties. This message will not be displayed on a roadway that has AET.

j)MassDOT may enter into reciprocal agreements with other agencies. If your E-ZPass transponder(s) is used at any toll facility, parking facility or other facility accepting E-ZPass as a payment mechanism you agree that all charges incurred in connection with the use of your E-ZPass transponder(s) will be charged to your account and that you are responsible for all such charges.

k)In accordance with 700 CMR 7.03(9), Two Axle Commercial Vehicles, as defined in MassDOT’s regulations, op- erating on certain ways where MassDOT assesses a toll are required to use E-ZPass to pay tolls and must enter and exit all toll plazas through a designated E-ZPass lane, where applicable. Two Axle Commercial Vehicles are not allowed to pass through a manual lane and are not allowed to pay cash at a cash toll booth on certain non- AET ways, unless there is no designated E-ZPass lane in operation at the time the vehicle passes through the toll interchange. You acknowledge and agree that any use of the manual lanes or PBP system to attempt to pay cash for a toll on certain ways is in violation of this provision by such Two Axle Commercial Vehicles and is prohibited. The registered owner of any such Commercial Vehicle may be subject to fines and penalties under MassDOT’s regulations, other applicable laws, and/or for breach of these Terms & Conditions. You agree that if you are in violation of this provision, you shall pay any such assessed fines and penalties.

l)A roadway or facility that has All Electronic Tolling (“AET”) does not have designated E-ZPass lanes and any lane

may be used by an E-ZPass account holder.

3. LOST/STOLEN AND DEFECTIVE TRANSPONDERS

a)You agree that you will notify the Customer Service Center immediately if your transponder(s) is lost or stolen. You agree that you are responsible for any costs associated with any and all uses of the E-ZPass transponder(s) assigned to your account prior to such notification. The replacement fee for lost or stolen transponder(s) is equal to the amount of the Transponder Fee and Transponder Administrative Fee applicable as of the replacement date.

b)Defective E-ZPass transponders must be brought or sent to a Customer Service Center for testing and evaluation.

At the discretion of MassDOT, defective E-ZPass transponders may be replaced free of charge. If the E-ZPass transponder shows signs of misuse or abuse you will be required to pay a fee per 3(a) above.

4. YOUR E-ZPASS ACCOUNT

a)You authorize MassDOT to access and charge all costs associated with the use of your E-ZPass transponder(s) to the credit/debit card listed on your application or your bank account, as applicable.

b)You authorize MassDOT to access and charge all fees associated with your participation in the E-ZPass Program and associated use of a transponder to your E-ZPass account and to the credit/debit card, bank account, or other chosen method of replenishment for your account. The Fee(s) authorized hereunder include, but are not limited to, transactional, administrative, periodic administrative (i.e. monthly, yearly, etc.), and any other type of fee(s), as may be set and assessed at MassDOT’s discretion from time to time without prior written notice. Information relating to such fees and a current Fee Schedule may be obtained by contacting the Customer Service Center or online at www.mass.gov/ezpassma. If you close your E-ZPass account, such fees will not be refunded, except as otherwise determined by MassDOT from time to time on the Fee Schedule.

c)You acknowledge that MassDOT may review periodically the activity in your account and adjust your replenish- ment amount, if applicable, to more accurately reflect the average monthly charges and fees incurred by you.

d)You shall not assign the obligations or benefits of this agreement without the express written consent of MassDOT or the Customer Service Center.

e)If you have selected “Automatic Account Replenishment” as the payment method for your E-ZPass charges, you agree that you are responsible for providing the Customer Service Center with a credit/debit card in good stand- ing (i.e., valid, not expired and below the maximum balance), a banking account with sufficient funds, or a positive balance in your manual replenishment account, at all times to cover the costs and fees associated with your use of the ETC transponder(s).

f)If you have selected “Manual, Credit/Debit, or Bank Account Replenishment” as the payment method for your E-ZPass charges and your balance falls to or below $0.00 you will be subject to the issuance of a Violation Fine and account termination. In lieu of account termination you may be allowed to retain your E-ZPass account,

provided any outstanding balance is paid in full and you enroll in an automatic account replenishment payment method which includes use of a valid credit/debit card or bank account.

g)You acknowledge and agree that MassDOT shall not pay any interest on any E-ZPass account pre-paid balance or any transponder deposit.

h)You acknowledge and agree that you will be charged a fee for each returned check for your E-ZPass Program account.

i)You certify that all information contained in your E-ZPass application is true and accurate. You agree to notify im- mediately the Customer Service Center if any of the information contained in your application changes, including but not limited to, changes to address, credit/debit card, bank account information, and vehicle and license plate information. Failure to do so may subject you to additional fines and fees.

j)Administrative fees may be billed directly to your account. You may contest the imposition of said administra- tive fees in writing to the Customer Service Center within sixty (60) days of the disputed charge. If the fee is rescinded, your E-ZPass account will be credited the amount of the rescinded fee.

k)Unpaid balances due to MassDOT may be turned over to a collection agency for enforcement and collection activities along with any other legal action that MassDOT is authorized to pursue to recover such monies owed.

5.VIOLATIONS AND “VIDEO TOLL” (V-TOLL) FEES

a)In cases where your E-ZPass transponder is not read, but an image of the vehicle’s license plate is captured in the lane and the license plate information for the vehicle is listed in your account, the appropriate toll amount shall be deducted from your account by use of the video image, referred to herein as a “video toll” or “v-toll.” A Video Toll (“V-Toll”) Administrative Fee shall also be applied to your account.

b)You acknowledge and accept that you are required to maintain your E-ZPass account in good standing at all times and that if your account balance falls to or below $0.00 you will be subject to a fine and penalties for unauthorized use of the ETC lane under 700 CMR 11.00 et. seq and 700 C.M.R. 7.04 et. seq.

c)You agree that in the event your account falls to or below $0.00 due to an expired or rejected credit card, an insuf- ficient bank account balance or an insufficient pre-paid balance and you proceed through an E-ZPass lane, you are in violation of the E-ZPass Program Agreement and MassDOT regulations, and you are subject to a violation and penalties under700 C.M.R. 11.00 et. seq. and 700 C.M.R. 7.04 et. seq.

d)Any use of an E-ZPass lane by a vehicle that is not listed on an E-ZPass account; an E-ZPass account not in good standing; or an invalid member of E-ZPass is prohibited, and the registered owner of any such vehicle is subject to a fine and penalties under MassDOT regulations. Any E-ZPass account holder who is not in good standing and travels on an AET roadway will be subject to the PBP process and will receive an invoice and the toll shall be at the PBP toll rate.

e)If you rent or lease a vehicle and receive an E-ZPass violation you are advised that under Massachusetts Law, MassDOT must issue a violation to the registered owner of the vehicle (the rental or leasing company). You agree that, upon receipt of the name and address of the renter/lessee along with sufficient proof or such rental or lease, MassDOT may issue the violation to the renter/lessee. You agree that you, as the renter/lessee will be liable for any violation issued to the license plate associated with your rented or leased vehicle during the term of your rental or lease agreement. MassDOT has no obligation or liability whatsoever in any rental or leasing agreement.

f)You are advised and acknowledge that violation enforcement cameras are used in the E-ZPass and AET lanes. You agree that if you are issued a violation for unauthorized use of the ETC System you are required to adhere to MassDOT’s regulations 700 CMR 11.00 et. seq. and 700 C.M.R. 7.00-7.12 et. seq. for the payment or appeal of any viola- tions. Under MassDOT’s regulations you must pay or appeal in writing any violation issued to you within sixty (60) days. You are advised and acknowledge that cameras are also used in the AET lanes for the purpose of PBP invoicing.

g)Failure to pay or appeal violation fines within the time period and in the manner described on the violation notice may result in additional Violation Administrative/Late Fees, the termination of your account, the non-renewal of your driver’s license and vehicle registration by the Registry of Motor Vehicles (RMV), and an RMV Non-Renewal “Mark- ing Fee,” along with any other legal action that MassDOT is authorized to pursue to recover such monies owed.

h)You agree that the information provided to, or contained in your E-ZPass Account can be used by MassDOT in any

administrative or legal proceeding by MassDOT to collect any monies owed by you to MassDOT.

6. DISPUTES/REFUNDS

In accordance with Section 169 of Chapter 25 of the Acts of 2009, the time permissible for an account holder to dis- pute an overcharge of the electronic toll system is three (3) years from the time of the overcharge. If you dispute any overcharge to your ETC account you agree to notify the Customer Service Center in writing at 27 Midstate Drive, Auburn, MA 01501, within such period. MassDOT will investigate the dispute and will make a good faith determination of whether an adjustment is warranted. You agree that the good faith determination of MassDOT with regard to your dispute shall be final and binding upon you.

7. DISCLAIMER

a)MassDOT shall have no responsibility or liability to you for any loss, cost, expense or damage to you, any pas- sengers or your vehicle, arising out of your failure to comply with any laws or regulations, or any terms and condi- tions of the E-ZPass Program Agreement, or out of your misuse or abuse of an E-ZPass transponder, or failure to follow instructions for the use and operation of E-ZPass transponder(s).

b)Under no circumstances shall MassDOT have any liability for any consequential, indirect, special, incidental, or punitive damages of any kind arising out of your participation in the E-ZPass or PBP Program.

c)Except for its obligations under paragraph 3 (b) above, MassDOT makes no representations or warranties, ex- press or implied, with respect to the merchant ability or fitness for a particular purpose or any other reason with respect to E-ZPass transponders and/or the E-ZPass Program.

d)Except as otherwise specified herein, MassDOT shall have no liability or obligation of any kind what so ever arising out of a) your use of or the performance of the E-ZPass transponder, b) any defect or malfunction of an E-ZPass transponder or any defect or malfunction in any E-ZPass lane, or c) the failure of any E-ZPass lanes to operate at any time or the unavailability of any E-ZPass lanes at any toll plaza.

e)MassDOT does not warrant that there will be any E-ZPass lanes, or that any particular number of E-ZPass lanes will be available at any toll plaza, or that E-ZPass will be available at any other facilities.

f)You agree to indemnify, defend, and hold harmless MassDOT from and against any and all damage, loss, cost,

expense, or liability relating to, arising from, or as a result of the use or performance of the E-ZPass transponder.

8. COLLECTION EXPENSES

You agree to pay MassDOT’s costs, including attorneys’ fees, required to enforce the terms and conditions of the E-ZPass Program and the collection of monies in connection with the use of your E-ZPass transponder(s).

9. NON-DISCLOSURE

In accordance with the provisions of G.L. c. 6C, Section 13 (a), MassDOT and the Customer Service Center shall hold all customer account information confidential, except as otherwise authorized for MassDOT administrative and legal proceedings.

10. GOVERNING LAWS

The E-ZPass Program Agreement shall be governed by the laws of the Commonwealth of Massachusetts. Any legal proceeding arising out of or under the E-ZPass Program Agreement shall be brought in Superior Court, Suffolk County in Boston, Massachusetts.

11. TERMINATION

You may terminate this agreement at any time by returning your transponder(s) to the Customer Service Center. Transponders should be returned in person or by first class prepaid mail. Transponders will remain the property of MassDOT under all circumstances. Upon termination of this agreement and return of your transponder(s), your account balance will be refunded to you. All outstanding charges will be deducted prior to refund.

12. MODIFICATIONS

MassDOT may change the “E-ZPass Program Terms and Conditions” at any time by giving customers notice thereof. The terms and conditions shall become effective seven (7) days after such notice has been given. No written notice is required, and you hereby waive any requirement that written notice be provided. Such notice may be given through any means, including, but not limited to, advertising such notice in the media, posting such notice on message boards along MassDOT’s toll roadways, posting such notice on the MassDOT website, or otherwise, as determined by MassDOT. If you have provided an electronic mailing address to MassDOT with your application, you authorize that such notice may be provided by sending such notice to that electronic mail address, in MassDOT’s discretion.

Effective as of December 2014

Document Attributes

Fact Name Fact Details
Application Purpose The E-ZPass MA application form is intended for individuals seeking to open an account for privately owned or leased 2-axle and 4-tire vehicles.
Contact Information Applicants can reach the E-ZPass MA Customer Service Center at 1-877-627-7745 or via fax at 1-508-786-5222 for assistance.
Account Replenishment Options Three payment methods are available for account replenishment: direct payment from a checking account, credit/debit card, or manual replenishment.
Monthly Fee A $2.00 monthly fee applies for e-mailing monthly account statements, which will be deducted from the account unless otherwise specified.
Vehicle Registration Requirement At least one vehicle must be listed for each transponder requested, and changes to vehicle information must be updated promptly.
Governing Law The E-ZPass Program Agreement is governed by the laws of the Commonwealth of Massachusetts, and any legal proceedings must occur in Suffolk County, Boston.

E Zpass Ma Application: Usage Instruction

Filling out the E-ZPass Massachusetts application form is an important step for individuals looking to manage their toll payments electronically. Once you complete the form, you will submit it to the E-ZPass MA Customer Service Center. Following this, you can expect to receive your transponder and account information, allowing you to begin using the E-ZPass system for convenient travel.

  1. Visit the official E-ZPass Massachusetts website at www.mass.gov/ezpassma to access the application form.
  2. Print the application form clearly to ensure all information is legible.
  3. Fill in your personal information, including your last name, first name, middle initial, email address, street address, city, state, and zip code.
  4. Provide your home, work, and cell phone numbers. If applicable, include your fax number.
  5. Select your preferred option for receiving your monthly account statement: via email, by mail, or online only.
  6. List all vehicles that will use your E-ZPass transponder, ensuring you include at least one vehicle for each transponder requested. Include the license plate number, plate type, state, make and model of the vehicle, and the year. Indicate if the vehicle is leased.
  7. Indicate the number of transponders you are requesting (maximum of four per account).
  8. Choose your toll payment option: either direct payment from a checking account, credit/debit card, or manual account replenishment. Fill in the necessary details for your chosen option.
  9. Read and acknowledge the terms and conditions of the E-ZPass program. Ensure you understand the implications of your choices.
  10. Sign and date the application form to certify that all information provided is true and accurate.
  11. Submit your completed application form via mail or fax to the E-ZPass MA Customer Service Center at 27 Midstate Drive, Auburn, Massachusetts 01501-1839 or fax to 1-508-786-5222.

Frequently Asked Questions

  1. What is the purpose of the E-ZPass MA application form?

    The E-ZPass MA application form is designed for individuals who wish to create an account for electronic toll collection in Massachusetts. This application is specifically for privately owned or leased vehicles with 2 axles and 4 tires. Those with vehicles that have more than 4 tires or commercial license plates need to follow a different process by contacting the E-ZPass MA Customer Service Center.

  2. How can I submit my application?

    You can submit your application in several ways. If you prefer to mail or fax your application, send it to:

    • E-ZPass MA Customer Service Center
    • 27 Midstate Drive
    • Auburn, Massachusetts 01501-1839

    For fax submissions, use the number 1-508-786-5222. Additionally, applications can be completed online at www.mass.gov/ezpassma.

  3. What information do I need to provide on the application?

    The application requires personal information such as your name, address, email, and phone numbers. You must also provide details about the vehicles that will use the E-ZPass transponders, including license plate numbers, vehicle make and model, and whether the vehicles are leased. Additionally, you will need to select a payment option for account replenishment and provide a 4-digit PIN number for account access.

  4. Are there any fees associated with the E-ZPass MA account?

    Yes, there is a $2.00 monthly fee for receiving a mailed account statement. If you choose to manage your account online, you can avoid this fee. Furthermore, if your account balance falls below a certain threshold, you may incur additional fees, including violation fines if you use the E-ZPass lane without sufficient funds in your account. It's essential to maintain a positive balance to avoid penalties.

Common mistakes

When filling out the E-ZPass MA application form, many individuals make common mistakes that can delay their application process. One significant error is failing to provide a clear and legible signature. Without a proper signature, the application may be deemed incomplete, leading to unnecessary delays.

Another frequent mistake is neglecting to list at least one vehicle that will use the E-ZPass transponder. The application requires this information, and without it, the application cannot be processed. Applicants should double-check that all vehicle details, including license plate numbers, are accurate and complete.

Many people also forget to select a payment option. The form offers several choices, such as direct debit from a checking account or credit card. Not indicating a preferred method can result in a rejected application. It’s crucial to ensure that the chosen payment method is clearly marked.

Providing incorrect or outdated personal information is another common pitfall. This includes errors in the name, address, or contact information. If the information does not match what is on record, it could lead to complications. Always verify that the details match your official documents.

Additionally, some applicants overlook the requirement for a 4-digit personal PIN number. This number is essential for accessing account information. Leaving this section blank will lead to further processing delays. It's a small detail, but it carries significant weight.

Many applicants fail to read the terms and conditions thoroughly. Ignoring this step can lead to misunderstandings about account responsibilities and fees. Understanding the terms helps avoid future issues with account management.

Some people also submit the application without including the initial payment if they choose manual account replenishment. This can lead to immediate rejection of the application. It's important to follow the instructions carefully and include any required payments.

Lastly, individuals often forget to update their accounts with any changes after submitting the application. If there are changes to vehicle information or personal details, these must be communicated promptly. Keeping the account updated is vital to avoid penalties or violations.

Documents used along the form

The E-ZPass MA Application form is a crucial document for individuals seeking to establish an E-ZPass account in Massachusetts. However, several additional forms and documents are often required or recommended to ensure a smooth application process. Below is a list of these documents, along with brief descriptions of their purposes.

  • Vehicle Registration Document: This document verifies the ownership or lease of the vehicle(s) listed on the application. It is essential for confirming that the applicant has the right to use the vehicle with the E-ZPass transponder.
  • Proof of Identity: A government-issued ID, such as a driver's license or passport, serves as proof of identity. This is necessary to authenticate the applicant's identity and prevent fraud.
  • Bank Account Information: Applicants choosing direct payment options must provide their bank account details. This information allows for automatic replenishment of the E-ZPass account when the balance is low.
  • Credit/Debit Card Information: For those opting to use a credit or debit card for account replenishment, this information is required. It enables the automatic deduction of toll fees from the card.
  • Lease Agreement (if applicable): If the vehicle is leased, a copy of the lease agreement may be necessary. This document confirms the terms of the lease and the lessee's authority to use the vehicle.
  • Initial Payment Receipt: If the applicant selects manual account replenishment, a receipt of the initial payment must be included. This ensures that the account is funded before use.
  • Account Authorization Form: This form allows the applicant to authorize someone else to access their E-ZPass account information. It is useful for individuals who may need assistance managing their accounts.
  • Monthly Statement Preference Form: This document indicates how the applicant prefers to receive their monthly account statements. Options include email, mail, or online access.
  • Customer Service Contact Information: Providing contact information for a secondary individual can be beneficial for account management. This ensures that someone else can assist if the primary account holder is unavailable.

These additional documents help streamline the application process and ensure that the applicant's account is set up correctly. Having all necessary paperwork ready can facilitate quicker approval and reduce potential delays in accessing E-ZPass services.

Similar forms

  • Driver's License Application: Similar to the E-ZPass MA Application, the driver's license application requires personal information, including name, address, and contact details. Both documents need to be filled out clearly and accurately to ensure proper processing.
  • Vehicle Registration Form: This form also collects vehicle information, such as the make, model, and license plate number. Like the E-ZPass application, it requires that the vehicle details be accurate and up-to-date.
  • Insurance Policy Application: An insurance application gathers personal and vehicle information, similar to the E-ZPass form. Both documents require the applicant to provide details that can affect the approval process and service delivery.
  • Credit Card Application: This application collects personal information and requires the applicant to select payment options. Just like the E-ZPass application, it involves authorizing payment methods and maintaining account details.
  • Bank Account Opening Form: This form requests personal identification and account preferences. Both the bank form and the E-ZPass application emphasize the importance of accurate information for account management.
  • Membership Registration Form: Similar to the E-ZPass application, this form requires personal information and may include options for account management. Both documents focus on maintaining up-to-date information for continued service.

Dos and Don'ts

When filling out the E-ZPass MA Application form, there are several important dos and don'ts to consider. Following these guidelines can help ensure a smooth application process.

  • Do read the entire application carefully before starting.
  • Do print clearly to avoid any misunderstandings.
  • Do provide accurate personal information, including your email and phone numbers.
  • Do list at least one vehicle for each transponder requested.
  • Do check your selected payment option thoroughly before submitting.
  • Don't leave any required fields blank; this could delay your application.
  • Don't forget to sign and date the application.
  • Don't use a vehicle not listed on your application for E-ZPass transactions.
  • Don't submit the application without verifying all details are correct.
  • Don't ignore any updates to your personal information or vehicle details after submission.

By adhering to these dos and don'ts, you can facilitate a more efficient and effective application process for your E-ZPass MA account.

Misconceptions

When applying for an E-ZPass Massachusetts account, there are several misconceptions that can lead to confusion. Here are eight common misunderstandings:

  • Only cars can use E-ZPass. Many believe that E-ZPass is exclusively for passenger vehicles. In fact, it is also available for privately owned or leased 2-axle and 4-tire vehicles. However, vehicles with more than 4 tires must follow different application procedures.
  • All vehicles can be added without limits. Some applicants think they can add an unlimited number of vehicles to their account. Each account can only request a maximum of four transponders. It's essential to list all vehicles that will be using the transponders on the application.
  • Application processing is instantaneous. There is a misconception that once the application is submitted, the account is active immediately. In reality, processing can take time, and users should not assume their account is ready until they receive confirmation.
  • Fees are optional. Some people believe that they can avoid fees associated with their E-ZPass account. However, there is a $2.00 monthly fee for account statements, and users must be aware of other potential charges, such as for insufficient balance or returned checks.
  • Transponders can be used in any vehicle. A common misunderstanding is that transponders can be used interchangeably among different vehicles. It is crucial to use the transponder only in the vehicles listed on the account. Failure to do so may result in fines.
  • Manual replenishment is the only option. Many applicants think they must manually add funds to their account. However, there are options for automatic replenishment through a bank account or credit/debit card, which can help avoid violations due to low balances.
  • Violations can be ignored. Some individuals believe they can disregard violation notices. This is a dangerous assumption, as ignoring these can lead to additional fines, penalties, and even suspension of the account.
  • Account information is not confidential. There is a misconception that personal account details can be shared freely. In fact, MassDOT is required to keep all customer account information confidential, except as authorized for administrative or legal proceedings.

Understanding these misconceptions is crucial for a smooth application process and ongoing use of the E-ZPass system. It is always best to read the terms and conditions carefully and reach out to customer service for any clarifications.

Key takeaways

When filling out and using the E-ZPass MA application form, several important considerations can help ensure a smooth process. Here are key takeaways:

  • Eligibility: The application is intended for privately owned or leased 2-axle, 4-tire vehicles only. Vehicles with more than 4 tires must follow a different application process.
  • Accurate Information: Ensure that all personal and vehicle information is filled out clearly and accurately. This includes your name, address, email, and vehicle details.
  • Transponder Request: You may request up to four transponders per account. It is essential to list at least one vehicle for each transponder requested.
  • Payment Options: Choose between different payment methods for account replenishment, including direct debit from a checking account or credit/debit card, or manual replenishment.
  • Account Management: Regularly update your account with any changes to your personal information or vehicle details to avoid penalties.
  • Monthly Fees: Be aware that there may be a monthly fee associated with your E-ZPass account, which can be deducted automatically if you provide authorization.
  • Account Status: Maintain your account in good standing by ensuring a sufficient balance. Falling below the required balance may result in fines or penalties.
  • Violation Awareness: Understand the consequences of using an E-ZPass lane without a valid transponder or if your account is not in good standing, which can lead to fines.
  • Customer Service: For any questions or issues, contact the E-ZPass MA Customer Service Center at 1-877-627-7745 for assistance.