Name: Last______________________________First_________________MI___

Mailing Address (where Pine Tree Pass should be sent):

_________________________________________________________________

City/Town____________________________State_________Zip_____________

Daytime Phone: ____________________________________________________

Evening Phone: _____________________________________________________

E-mail address: _____________________________________________________

Estimated Date and Time of Arrival in Maine: Date _______Time ______am / pm

Estimated Date and Time of Departure from Maine: Date _____ Time ______am / pm

Payment Type and Amount Enclosed (Please check one): ___$10.00 check

                                                                                       ___$10.00 money order

· All Pine Tree Pass Applications must be received at the MTA by July 10, 2000.

· Pine Tree Passes are valid from August 9, 2000 to August 29, 2000.

· Pine Tree Passes may only be used on motor coach vehicles.

· Pine Tree Passes must be displayed in a visible location on driver’s side of windshield.

· The MTA reserves the right to revoke any Pine Tree Pass for improper use.

If you have questions, please call our customer service center toll free at 1-888-MTA-PASS (1-888-682-7277) Monday-Friday, 8 a.m. to 6 p.m.
Visit our Web Site at www.maineturnpike.com.