E Zpass Ma Application Template Access E Zpass Ma Application Editor Now

E Zpass Ma Application Template

The E-ZPass MA Application form is essential for individuals in Massachusetts seeking a convenient way to handle toll payments for their privately owned or leased 2-axle, 4-tire vehicles. This form, available for submission via mail or fax, simplifies the process of obtaining a transponder that enables electronic toll collection, thereby offering a smoother and more efficient travel experience on toll roads. For residents interested in taking advantage of this service, click the button below to learn more about how to fill out and submit your E-ZPass MA Application form today.

Access E Zpass Ma Application Editor Now
Table of Contents

The E-ZPass MA Application form serves as the initial step for individuals in Massachusetts to access electronic toll payment for privately owned or leased 2-axle, 4-tire vehicles. Available through the Massachusetts Department of Transportation (MassDOT), this form facilitates the establishment of an Individual E-ZPass Massachusetts Account, integral for the automated toll transactions on Massachusetts' toll roads. Applicants are advised to provide comprehensive personal and vehicle information, including a unique 4-digit personal identification number (PIN) for account access. The form outlines various account management options, including statement delivery preferences and lists all vehicles to be associated with the E-ZPass transponders requested. Payment options are clear-cut, offering direct payment from checking accounts, credit or debit cards, or manual account replenishment, each with a set opening account balance requirement. Additionally, the terms and conditions section details the responsibilities and expectations of account holders, emphasizing the need for accurate and current information, adherence to toll payment, and the protocols for lost, stolen, or defective transponders. Furthermore, it explicates the procedures for disputes, refunds, and the consequences of violations, underscoring MassDOT’s authority to enforce terms and manage the E-ZPass Program. This comprehensive form ensures applicants are well-informed of the process, obligations, and benefits of participating in the E-ZPass system.

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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

Form Breakdown

Fact Name Description
Application Purpose For privately owned or leased 2-axle, 4-tire vehicles only. Commercial vehicles require a separate application process.
Contact Information Applicants can apply via mail, fax, or join online through the E-ZPass MA website.
Personal Information Requirement Application requires detailed personal information including vehicle description and a 4-digit PIN for account access.
Statement Options Applicants can choose between receiving a monthly statement via email, mail, or access it online to avoid a monthly fee.
Transponder Request Limit A maximum of 4 transponders can be requested per account.
Toll Payment Options Direct payment can be made from a checking account or credit/debit card, or through manual account replenishment.
Program Agreement Terms Using an E-ZPass transponder indicates agreement with terms set by MassDOT, including account maintenance obligations and compliance with applicable laws.
Governing Laws The E-ZPass Program Agreement is governed by the laws of the Commonwealth of Massachusetts.

Guidelines on Filling in E Zpass Ma Application

After completing the E-ZPass MA Application form, you're on track to enjoy the convenience of electronic toll collection in Massachusetts. This quick guide will help you fill out your application correctly. Once submitted and processed, you'll receive your E-ZPass transponder(s), allowing you to pay tolls automatically without stopping at toll booths. Now, let's walk through the steps to fill out your application.

  1. Visit www.mass.gov/ezpassma for additional details or to apply online. Alternatively, you can mail or fax your application to the address or fax number provided at the top of the form.
  2. Under "Personal Information," enter your full name (Last Name, First Name, MI), email, full address, and contact numbers as it appears on your vehicle registration. This information is critical for account setup and communication.
  3. In the "Statement Options" section, indicate your preferred method of receiving monthly account statements. You can choose between email, mail (with a $2.00 monthly fee), or not receiving a statement and checking online instead.
  4. In the "Vehicle Information" section, list all vehicles that will be using the E-ZPass. Include License Plate Number, Plate Type, State, Make & Model of Vehicle, and Year. Mark if any vehicle is leased.
  5. For the "Transponder(s) Requested" section, state how many transponders you’re applying for. A maximum of 4 per account is allowed.
  6. Choose your "Toll Payment Options." You can select either direct payment from a checking account (Option B) with an accompanying $20 opening account balance, direct payment from a credit/debit card (Option C) with the same opening balance requirement, or manual account replenishment (Option D), also requiring a $20 opening balance. If selecting Option B, provide your checking account routing and account numbers, or attach a voided check. For Option C, select your card type and provide the card number and expiration.
  7. Sign and date the application form in the "Authorization" section, certifying that all information provided is accurate and agreeing to the terms and conditions of the E-ZPass service.
  8. Mail or fax the completed form to the address or fax number provided if not completing the form online.

Submitting your application is the first step to easier and faster toll payments. Once your application is processed, you will receive your transponder(s) and can begin enjoying the benefits of E-ZPass MA. Remember to mount your transponder correctly in your vehicle to ensure tolls are accurately recorded.

Learn More on E Zpass Ma Application

What is E-ZPass MA and how does it work?

E-ZPass MA is an electronic toll collection system that allows you to pay tolls without stopping at a toll booth. When you set up an E-ZPass MA account and receive a transponder, you attach it to your vehicle. As you drive through designated E-ZPass lanes, tolls are automatically deducted from your prepaid account balance. You'll see a green “Thank You” light flash, indicating a successful toll transaction.

Who can apply for an E-ZPass MA account?

The application is intended for individual users owning or leasing privately owned 2-axle, 4-tire vehicles. Operators of vehicles with more than 4 tires or those with commercial, livery, taxi, or combination license plates should contact E-ZPass MA customer service for a Commercial Business Account Application.

How do I apply for an E-ZPass MA account?

To apply, you can either visit www.mass.gov/ezpassma to join online or mail or fax your application form to the E-ZPass MA Customer Service Center at the address provided on the application.

What information do I need to provide in my application?

Applicants must provide personal information such as name, address, phone numbers, and email. Vehicle information including license plate number, state, make, model, and year of each vehicle the transponder will be used with are also required. Additionally, you must choose a toll payment option and provide payment information according to your selected method.

How many transponders can I request?

You can request a maximum of four transponders per individual E-ZPass MA account.

What are the toll payment options available?

Three main toll payment options are available for E-ZPass MA accounts:

  1. Direct Payment from Checking Account (Option B)
  2. Direct Payment from Credit/Debit Card (Option C)
  3. Manual Account Replenishment (Option D)

Each payment option has different requirements and processes for account replenishment.

Is there a fee for requesting a monthly account statement?

Yes, if you opt to receive a monthly account statement by mail, there is a $2.00 monthly fee. This fee is automatically deducted from your E-ZPass MA account. Alternatively, you can access your account statement online for free.

What should I do if I change vehicles or my personal information changes?

It's crucial to keep your account information up to date. If you change vehicles or your personal details change, such as address or license plate number, you must promptly inform the E-ZPass MA Customer Service Center. This helps ensure your account works correctly, and you avoid any potential issues or violations.

What happens if my transponder is lost, stolen, or defective?

If your transponder is lost or stolen, immediately contact the E-ZPass MA Customer Service Center to avoid unauthorized charges. For defective transponders, you can bring or send them to a Customer Service Center for testing and evaluation. Defective units may be replaced free of charge unless there are signs of misuse or abuse, which may then require a fee.

Common mistakes

When completing the E-ZPass MA Application form, attention to detail is crucial. Mistakes can delay the process or lead to inconveniences in using the service. Below are seven common errors to avoid:

  1. Incorrect Personal Information: Entering wrong details in the Personal Information section, such as your name or address that does not match with your vehicle registration, can create issues with your account.
  2. Forgetting to Choose a PIN: The 4-digit Personal Identification Number (PIN) is essential for accessing your account information and managing your account online or over the phone. Skipping this step can limit your access to your account.
  3. Omitting Vehicle Information: Each vehicle using the E-ZPass transponder needs to be listed on the application. Failure to provide complete details, including license plate number and vehicle make and model, can lead to toll violations.
  4. Ignoring the Toll Payment Options: Applicants must select one method to replenish their E-ZPass balance. Not choosing an option or providing incomplete information for the selected method can result in account deactivation or insufficient funds when passing through a toll.
  5. Not Signing the Authorization Section: The application process requires your signature to validate the information and agree to the E-ZPass terms and conditions. An unsigned application is considered incomplete and will not be processed.
  6. Choosing the Wrong Account Type: This application is specifically for privately owned or leased 2-axle, 4-tire vehicles only. If your vehicle does not fit this description, such as having more than 4 tires or commercial license plates, it requires a different type of account.
  7. Incorrect Payment Information: When opting for automatic replenishment from a checking account or credit/debit card, ensuring the account numbers and routing numbers are correct is essential. Mistakes here can lead to transaction failures and possible toll violations due to insufficient funds.

Remember, always double-check your application for accuracy and completeness before submitting it to prevent any issues with your E-ZPass MA account.

Documents used along the form

When applying for an E-ZPass MA account, individuals frequently need to provide additional documents to ensure a smooth and accurate process. These documents are essential for verifying personal and vehicle information, which allows for the efficient usage of the E-ZPass system for toll payments. Below is an overview of such documents often required alongside the E-ZPass MA Application form.

  • Vehicle Registration: This document proves the ownership or leasing status of the vehicle(s) listed in the application. It is essential for verifying that the vehicle information provided matches state records.
  • Valid Driver's License: A driver's license helps to confirm the identity of the applicant and ensures that they are legally permitted to operate the listed vehicle(s).
  • Proof of Residence: Utility bills or a lease agreement can serve as proof of residence, confirming the applicant's current address. This is crucial for mailing the transponder(s) and any communication.
  • Voided Check or Bank Statement: For those opting to replenish their E-ZPass account directly from a checking account (Option B), a voided check or recent bank statement could be required to verify banking details.
  • Credit or Debit Card Information: Applicants choosing to replenish their account using a credit or debit card (Option C) must provide accurate and up-to-date card information to facilitate automatic payments.
  • Manual Account Replenishment Agreement: For users selecting manual account replenishment (Option D), a signed agreement or initial payment may be necessary to activate the account with a prepaid balance.

It's important to gather these documents before submitting the E-ZPass MA Application form to minimize delays in processing. Each document plays a critical role in verifying the account holder's information, ensuring the legality of the vehicle's operation, and setting up the preferred toll payment method. Accurate and complete documentation will contribute to a seamless onboarding process for new E-ZPass MA account holders.

Similar forms

The E-ZPass MA Application form is an essential document for those seeking to use Massachusetts' toll roads more efficiently. Similar documents, while unique in their purpose, share commonalities in how they solicit personal and payment information, authorize transactions, or establish terms of use. Below is a list of ten documents that mirror aspects of the E-ZPass MA Application in structure or intent:

  • Driver's License Application: Like the E-ZPass application, it collects personal information, vehicle details, and requires a signature and payment authorization, typically for processing fees.
  • Rental Car Agreement: Rental agreements collect driver information, set terms for vehicle use, and often require a method of payment for automatic tolls, similar to the toll payment options in the E-ZPass application.
  • Bank Account Opening Form: Similar to the E-ZPass application, this requires personal information, authorization for direct debits or credits, and may include setting up automatic payments or deposits.
  • Credit Card Application: It gathers personal and financial information and involves agreeing to terms of use, just as the E-ZPass form outlines terms and conditions for toll payments.
  • Online Service Subscription Form: Forms for services like streaming or software subscriptions collect personal and payment information and include agreeing to service terms, paralleling sections of the E-ZPass application.
  • Parking Pass Registration: This involves providing vehicle information, selecting payment options for parking fees, and can include automatic account replenishment features similar to those of E-ZPass.
  • Toll Violation Dispute Form: Both documents necessitate personal and vehicle information submission, with the context focused on toll usage, albeit for contesting charges in the case of a dispute form.
  • Loan Application Form: Much like applying for an E-ZPass, applying for a loan involves sharing personal and financial information, and agreeing to terms, including repayment options.
  • Vehicle Registration Form: This requires detailed vehicle information, ownership data, and may include payment information for registration fees, closely aligning with the vehicle section of the E-ZPass application.
  • Gym Membership Agreement: Similar in structure to the E-ZPass application, gym agreements require personal information, set forth terms of membership, and often involve recurring payment authorizations.

Each of these documents, while serving different purposes, shares the procedural ethos of the E-ZPass MA Application: collecting data, establishing an agreement between parties, and facilitating payment or service transactions.

Dos and Don'ts

Filling out the E-ZPass MA Application form requires attention to detail to ensure accuracy and compliance. Here are some do's and don'ts to consider during the process:

Do:
  • Ensure personal information matches the vehicle registration: Confirm that the name and address details align with what's listed on your vehicle registration documents.
  • Opt for electronic statements if possible: Choosing to receive statements via email can save time and reduce paper waste.
  • List all vehicles using the E-ZPass transponders: To avoid violations, make sure each vehicle that will use the transponder is listed on the application.
  • Choose a convenient toll payment option: Whether through a checking account, credit/debit card, or manual replenishment, select the method that best fits your lifestyle and financial situation.
  • Sign the application: A signature is required to process your application, acknowledging the terms and ensuring that all information provided is accurate.
  • Keep a copy of the completed form: Having a record can be helpful for reference or if any disputes arise regarding your account.
  • Regularly update your account information: Changes in vehicles, license plates, or personal information should be promptly reported to keep the account current.
Don't:
  • Leave sections incomplete: Failing to provide required information could delay processing or result in the denial of your application.
  • Misreport vehicle information: Incorrectly listing make, model, year, or license plate number can lead to toll violations.
  • Select more than one statement option: Choosing more than one method for receiving your statements can cause confusion and processing delays.
  • Forget to include a personal PIN: The PIN is vital for accessing account information online or over the phone. Ensure it's a number you'll remember.
  • Ignore the toll payment options instructions: Each payment option has specific requirements. Overlooking these might result in a failed account setup.
  • Use unclear handwriting: If the form is filled out manually, ensure your handwriting is legible to avoid errors in your application processing.
  • Omit the signature and date: An unsigned application is considered incomplete and will not be processed until corrected.

Misconceptions

There are many misconceptions regarding the E-ZPass MA Application form. Let's clear up ten common ones:

  • Everyone can use the standard application form regardless of vehicle type. This is untrue. The standard application is specifically for privately owned or leased 2-axle, 4-tire vehicles. Operators of vehicles with more than 4 tires or vehicles used for commercial purposes need to use a different application process.
  • You can't update your information once you submit the application. Incorrect. Keeping your account updated with any changes in vehicles or personal information is not only allowed but encouraged to ensure accurate toll billing.
  • You must receive a monthly statement in the mail. Not necessarily. While you can opt to have your monthly statement mailed to you, E-ZPass MA also offers the option to access statements online or receive an email link, potentially avoiding the monthly mail statement fee.
  • E-ZPass does not require a PIN number for account access. In reality, a 4-digit PIN is essential as it helps secure your account, allowing safe access to account information online or over the phone.
  • Selecting the payment method locks you in without option for change. This is false. While you choose a payment method upon application, you can update your preference to better suit your needs as they evolve.
  • Email address is only for marketing communications. This misunderstanding overlooks that providing an email address can be for critical account alerts or to receive an electronic link to your monthly statement, beyond just marketing.
  • There is a fee for all types of account replenishment. Actually, while some replenishment methods, like manual account replenishment, might have associated costs, others, like automatic deduction from a checking account or credit card, may not have such fees.
  • You can request an unlimited number of transponders. This isn't the case. There's a cap on the number of transponders you can request per account, which is typically four.
  • Cash is not an acceptable form of payment for the E-ZPass. This is not true. Although electronic payments are encouraged for convenience and efficiency, cash payments are still an option through designated retail locations, albeit with a convenience fee.
  • Application acceptance is guaranteed. Each application undergoes review, and the Massachusetts Department of Transportation (MassDOT) reserves the right to reject any E-ZPass MA application based on the criteria they set forth.

Understanding these points ensures a more seamless application process for the E-ZPass MA, helping applicants set up their accounts accurately and maintaining them effectively over time.

Key takeaways

When filling out and using the E-ZPass MA Application form, there are several key takeaways to consider for a smooth and efficient experience. Below is a guide to ensure you get the most out of your application:

  • Initially, check if your vehicle is eligible for the E-ZPass MA, as the application is designed for privately owned or leased 2-axle, 4-tire vehicles only. Owners of vehicles that don't fit this description, such as those with more than 4 tires or commercial vehicles, must call for a different account type.
  • Ensure that all personal information is filled out clearly and accurately on the application form to prevent any issues with your account setup or communication.
  • A 4-digit PIN is required for accessing your account information online or over the phone. Choose a unique number that you'll remember but is secure.
  • Choose how you would like to receive your monthly account statement. You can opt not to receive a physical mail statement to avoid a $2.00 monthly fee, favoring email communication or online management for a more eco-friendly and cost-effective option.
  • List all vehicles that will use the E-ZPass transponders. It's mandatory to include at least one vehicle per transponder requested, covering details from license plate number to vehicle make and model.
  • Clearly indicate the number of transponders you're requesting with your application, keeping in mind that there is a maximum of 4 transponders per account.
  • Decide on a toll payment option that works best for you. Options include direct payments from a checking account or credit/debit card for automatic account replenishment or manual account replenishment where you're in charge of keeping your balance funded.
  • Read and understand the agreement terms, acknowledging MassDOT’s authority to suspend or terminate accounts, adjust terms, and manage the toll payment processes in line with regulations.
  • Know your obligations towards the transponder, including proper installation, vehicle updates, and its use exclusively in listed vehicles to avoid fines or penalties associated with misuse or incorrect use.
  • Understand the processes and liabilities associated with lost, stolen, or defective transponders, ensuring prompt reporting and replacement to maintain uninterrupted service and avoid unauthorized toll charges.

By following these guidelines, you'll be better prepared to manage your E-ZPass MA account effectively, benefiting from the convenience and efficiency of electronic toll collection.

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