EmailMe Form - SECTION 132 TRANSPORTATION ELECTION FORM

Please check box: *
New Enrollment
Company Name *
Name *
First Last
Email *
Social Security Number *
Employee I.D. *
***All future communications will arrive via email address and/or mail address on file ***
Phone *
### - ### - ####
Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
SECTION 132 TRANSPORTATION ELECTION AUTHORIZATION MASS TRANSIT AND PARKING BENEFIT
Select pay Cycle *
Weekly
Semi Monthly
Other
2014 Commuter Benefit maximum is $130.
Please select your monthly election amount and enter the amount below, the maximum Commuter Benefit is $130 per month and the minimum is $20. The combined total for Parking and Commuter Benefit/Van Pool is $380.
Enter amount here
Commuter Benefit
I authorize MY EMPLOYER to deduct, on a pre-tax basis, per month from my paychecks, for the purpose of my participation in the Employee Transportation Program. (This program is described in Internal Revenue Code Section 132(f).
Enter amount here
Parking Benefit
I authorize MY EMPLOYER to deduct, on a pre-tax basis, per month from my paychecks, for the purpose of my participation in the Employee Parking Benefit Program. (This program is described in Internal Revenue Code Section 132(f).
Authorization and Electronic Signature
Please read and check the box below
I authorize MY EMPLOYER to deduct, on a pre-tax basis, the amount stated above per month from my paychecks, for the purpose of my participation in the Employee Transportation Program. (This program is described in Internal Revenue Code Section 132(f)). Electronic Signature Agreement. By checking the “box”, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By checking the “box” you consent to be legally bound by this Agreement's terms and conditions.
Checkbox *
I agree
Please read and check the box below
Electronic Signature Agreement. By checking the “box”, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By checking the “box” you consent to be legally bound by this Agreement's terms and conditions.
Checkbox *
I agree

***All future communications will arrive via email address and/or mail address on file ***

SECTION 132 TRANSPORTATION ELECTION AUTHORIZATION MASS TRANSIT AND PARKING BENEFIT

Authorization and Electronic Signature

All future communications will arrive via email address and/or mail address on file