Rider Application


RIDER INFORMATION

EMERGENCY CONTACT INFORMATION

SERVICE INFORMATION

** Rider requesting service may qualify for a reduced fare if he/she is over the age of 60 or has a verifiable disability. (Note: Residents in certain contract cities are not eligible and other restrictions may apply.) The Disability Certification Form can be found here.

The application must be filled out completely and legibly. The enclosed Physician’s Certification of Disability Form must be completed by a doctor or human services professional familiar with your disability.

Once completed, please return the form via email (span@span-transit.org), via fax (940-383-8433), via US Mail, or in person (Span, 1800 Malone Street, Denton, TX, 76201).

ACKNOWLEDGEMENT

**If someone other than the rider is completing this form or has assisted the rider, that person must complete the following: