Rev-9/10/18
I. PERSONAL INFORMATION
State
II. VEHICLE INFORMATION
Tag Fee
+
Plan Fee
IV. ADDITIONAL PREPAID TOLL BALANCE FOR THOSE PATRONS PAYING WITH CREDIT CARDS
V. PAYMENT METHOD
Credit Cash Check
(Make Checks payable to : WV Parkways Authority)
Check card type: Visa Mastercard American Express Discover
_______ /_________
Card Holder Signature______________________________________________
VI. CUSTOMER AGREEMENT
I agree to the terms and conditions included with the application and confirm that I have read, understand and will comply with them. Terms must be
signed on back of application.
Signature____________________________________________________ Date_________________________________
Method of payment for account start up: (Circle One)
Credit Card Number
Telephone: 1-800-206-6222. Fax 304-926-3748
The WVPA Customer Service Center addresss is:
West Virginia Parkways Authority, Customer Service Center
3310 Piedmont Rd., PO Box 1469, Charleston, WV 25325-1469
Unless checked, account will
automatically renew.
Make Model Year Color
License Plate
State & Number
List all vehicles for which you are purchasing an E-ZPass
Secondary Contact - Name
Zip Code
Cell Number (Optional)
Mailing Address
Home Phone
Email Address
First Name
Middle Initial
WEST VIRGINIA PARKWAYS AUTHORITY
PERSONAL ACCOUNT APPLICATION
(Private Passenger Vehicles Only)
Last Name
When the prepaid account balance falls below $ ___________ ($10 minimum), replenish balance in the amount of $_________ ($20 minimum).
Name on Credit Card ______________________________________________
Expiration Date
III. WEST VIRGINIA PERSONAL ACCOUNT SINGLE FEE DISCOUNT PLAN - LIMITED TIME OFFER
*The WV Parkways is offerng an early enrollment special for both new and existing customers who enroll in the new Single Fee Discount Plan prior to
January 1, 2019. New/existing customers will pay $24, which will include unlimited use of all WV Turnpike Toll Plazas through December 31, 2021. All
applications will be subject to a one time $13 issuance fee per transponder. The Single Fee Discount Plan is not valid when your Toll Class 1 vehicle is
towing. The Single Fee Discount Plan and transponder issuance fee are non-refundable.
A prepaid balance can be used whenever the passenger vehicle is towing and can also be used anywhere E-ZPass is accepted. Tolls will be
debited against this balance. As part of this option you agree to have your account automatically replenished when the account balance
falls below $10.00. The prepaid amount may be adjusted to reflect your average monthly account activity. You will be notified of any
changes regarding your account.
*EARLY ENROLLMENT LIMITED TIME OFFER EXPIRES DECEMBER 31, 2018
New and Existing customers - Number of Transponders ($13 each) and Plans
($24 each) requested ________________ X
$37.00
Total
$ 0.00
$ 0.00
$ 0.00
WVPA E-ZPASS
TM
PERSONAL ACCOUNT AGREEMENT
These Terms and Conditions together with your application constitute your WVPA E-ZPASS
TM
Agreement. Please read the entire agreement prior to using the WVPA E-ZPASS
TM
transponder.
Once your transponder is used, you agree to the following:
1) Terms.
Failure to comply with the Agreement may result in termination of your account. Failure to
pay tolls may result in additional penalties provided for by law and/or termination of your
account and an administration fee of up to $25 per occurrence.
2) Tag Use
a) You must comply with all applicable traffic laws and regulations.
b) As you approach and pass through a toll lane, you will, under no circumstances, exceed a
speed of 5 miles per hour.
c) You may not assign the obligations or benefits of this Agreement.
3) Your Account
a) You are responsible for your transponder. The transponder cannot be transferred to
another person. Our Agreement is only with the person on this application.
b) All accounts are prepaid with credit card, cash, check or money order.
c) This program is valid only for use when operating or traveling in one of the “TOLL CLASS
1” MOTOR VEHICLES that is listed on your application. Each transponder registered to an
account can only have one qualified motor vehicle assigned to it. A “TOLL CLASS 1”
vehicle is defined as a motor vehicle of a passenger type or truck with a gross vehicle
weight of not more than 8,000 pounds, not more than 7’6” in height, has no more than 2
axles, not used for commercial or business use and registered or eligible for registration
as a “CLASS A” vehicle in accordance with Section I, Article 10, chapter 17a of the West
Virginia Code.
d) You tag will not be valid when your vehicle is towing anything. Unless you have set up
your account with the prepaid toll balance option you must use a staffed lane and pay
the toll fare when your vehicle is towing. See 5c) below)
e) When purchased prior to January 1, 2019, the Single Fee Discount plan will be valid
through December 31, 2021. If the automatic renewal option is not chosen, then the
Single Fee Discount Plan will expire on December 31, 2021. Accounts may be re-validated
by submitting a renewal application within fifteen (15) days prior to the expiration date.
Renewals of the Single Fee Discount Plan will be $25 for a period of one year. Your
renewal payment will authorize continued use of the transponder. Renewal notices may
be mailed out one month prior to the expiration date. For accounts set up with a credit
card or bank account information, the Single Fee Discount Plan will be automatically
renewed unless we are notified of termination. Single Fee Discount Plans purchased after
December 31, 2018 are $25 per year and may be subject to a one time transponder
issuance fee.
f) Unless otherwise specified, account expiration dates will be one year from date of
activation.
g) Refunds – The Single Fee Discount Plan and transponder issuance fee are non-refundable.
4) Account Status
Statements may be issued on a monthly basis for accounts with revenue transactions. A
fee of $1.00 will be charged for statements delivered by US Mail. No fee will be charged
for statements delivered by email.
5) Payments
The following payment options are available for individual patrons:
a) Credit Card Payment Option – You authorize WVPA to charge your credit card for the
initial Single Fee Discount Plan plus your, one time, $13 transponder issuance fee (unless
you already have a valid transponder). Your account will automatically renew, prior to
expiration, unless you contact the Customer Service Center at 1-800-206-6222 and
request that your account be taken off auto renew.
b) Cash, Check or Money Order Payment Option – Your Early Enrollment Option application
must be accompanied by a check or money order for the amount of $24 for the Single
Fee Discount Plan and one time transponder issuance fee of $13 and made payable to
the West Virginia Parkways Authority. Cash payments may only be made in person at the
Customer Service Center.
c) Additional Prepaid Toll Balance Option For Those Patrons Paying with Credit Cards – A
prepaid toll balance may be established to pay discounted toll rates if your “TOLL CLASS
1” vehicle is towing and can also be used anywhere E-ZPass
TM
is accepted. Tolls will be
debited against this balance.
5c continued - As part of this option you agree to have your account automatically
replenished when the account falls below $10. The prepaid amount may be adjusted to
reflect your average monthly account activity. You will be notified of any changes
regarding your account.
6) Violations
Improper use of your WVPA E-ZPass
TM
tags, improper speeds through toll lanes or failure
to pay the proper toll may result in an administrative fee and/or loss of tag privilege. The
administrative fee will be in addition to the toll amount and may be up to $25 per
occurrence.
7) Lost / Stolen or Defective Tags
You will not be liable for unauthorized tag usage that occurs after we receive written
notice from you via mail or fax (304-926-3748). You will be liable for toll charges incurred
prior to notification. Please contact the WVPA Customer Service Center if you wish to
replace your tag(s). Defective tag(s): If your WVPA E-ZPass
TM
tag(s) is non-operational for
reasons other than abuse or improper use, and the tags(s) is returned to us, we will
replace it at no charge to you. Otherwise, you will pay the issuance fee of $13 to replace
the tag. If your tag is damaged due to defacement you will pay the issuance fee of $13 to
replace the tag.
8) Disclaimer
To the extent permitted by law, we expressly disclaim any representation or warranty,
expressed or implied, relating to the WVPA E-ZPass
TM
tag, including, without limitation,
any implied or expressed warranty of merchantability, fitness for a particular purpose, or
conformity to models or samples. Nor are we liable for any third party action taken by
reason of your use or display of the WVPA E-ZPass
TM
tag. You agree to indemnify us and
hold us harmless from and against any and all claims damages, loss, costs, expenses or
liability relating to, arising from, or as a result of the use or performance of the WVPA E-
ZPass
TM
tag.
9) Termination
You may terminate this Agreement at any time by returning your transponder to the
address on the front label of your transponder.
10) Collection Expenses
You agree to pay all costs, including attorney’s fees, incurred by us to collect any monies
due under the terms of this Agreement.
11) Modification
We may change the Terms and Conditions at any time. You will be bound by any revised
Terms and Conditions provided with your account statement (consistent with the form of
statement requested upon application). First use of tag after effective date of new Terms
and Conditions will constitute your acceptance. A copy of the revised Terms and
Conditions will be mailed to you upon request. The invalidity of any term or terms of this
Agreement shall not affect any other term of this Agreement, which shall remain in full
force and effect. You agree to inform us in writing of any changes to the information
provided by you in your WVPA E-ZPass
TM
application such as:
• Change of address
• Change in credit card account status (closed account, maximum credit use)
• Expiration date of credit card account
12) Governing Law
This agreement shall be governed by and construed in accordance with the laws of the
State of West Virginia.
13) Non-Disclosure
Customer account information will not be disclosed to third parties without your consent,
except as permissible by law and our policy.
14) Inquiries and Correspondence
Please send application to:
West Virginia Parkways Authority, Customer Service Center, 3310 Piedmont Road PO Box
1469 Charleston, WV 25325-1469
All telephone inquiries may be made toll-free by calling 1-800-206-6222. If using a fax
please dial 304-926-3748
1. _______ I agree not to exceed the speed limit of 5 miles per hour within designated
areas of the toll plazas.
2._______ I understand the single fee Discount plan is not valid when I am towing
anything. (Example: Boat, Camper, Trailer or anything that changes the number of
axles).
3._______ I understand that I may add prepaid funds to my account to be used for
payment in the event that I am towing or for payment at other E-ZPass
TM
agencies.
4._______ I understand that this transponder is only to be used with one “Toll Class
1” vehicle that is under 7’6” in height, does not exceed 8,000 pounds, and has no
more than 2 axles.
5._______ I understand that this transponder cannot be used on any commercial
vehicle or in relation to any business / company.
6. _______ I understand that if my transponder is Lost / Stolen / Damaged or Defaced
I must pay the issuance fee of $13 to replace it.
7._______ I understand the Single Fee Discount plan is sold for a period of one year
and the time is not pro-rated and if I cancel my account prior to the expiration of the
plan I will not be refunded for any remaining time.
8._______ I understand that non-compliance with any of the listed Terms may result
in an administrative fee of $25 for each occurrence and / or termination of account.
9._______ I understand that in order to cancel my service I must submit a request in
writing to the West Virginia Parkways Authority or I may do so online.
10._______ I understand that because my name is listed on the application that I am
responsible for all fees and violations regarding the use of the transponder(s). Even
if it was not I that committed the violations.
Personal Account
Initial next to each Term/Condition indicating your acknowledgement and acceptance