Staten Island Resident Car Pool Ticket Book Order Form

1) Enclose check or money order for $ 55.92 payable to TBTA. (Please do not send cash.)
2) Check must be signed by vehicle's driver or member of the immediate family with the same surname.
3) Orders are limited to one (1) 24-trip book per application.
4) Please write license plate number on the front of the check.
Vehicle Owners Name: ___________________________________________
Street __________________________________________________
City ___________________________ State _______ Zip _______
License Plate No. _________________
IMPORTANT READ THIS BEFORE ORDERING!
Car Pool tickets are valid only at the Verrazano-Narrows Bridge for passenger vehicles displaying a
valid Staten Island Resident Sticker with three or more occupants.
For additional information please call 646-252-7513.

Please mail this form and your check to:
TBTA Staten Island Car Pool Program
2 Broadway - 23rd Floor
New York, NY 10004 

Download Order Form PDF Format:

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