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Clipper cancellation form

Clipper cancellation form 2026

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The document is a cancellation form for Clipper cards, detailing the process to cancel a card and request a refund for eligible transit cash value, parking value, and unused passes. It outlines the necessary steps, including providing personal information, reasons for cancellation, and payment details for a $5 processing fee. Refunds are subject to specific conditions and will be mailed within 30 days.

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Click ‘Get Form’ to open the clipper cancellation form in the editor.
Enter your Clipper Card Serial Number, which is a 10-digit number located on the back of your card.
Fill in your Cardholder Contact Information. Ensure that this matches your registered details, including your first name, last name, billing address, and phone numbers.
Indicate your Reason for Cancellation by checking all applicable boxes. Options include moving out of the area or dissatisfaction with the Clipper program.
Provide Payment Details and Credit Card Authorization. Enter your credit card type, number, security code, and expiration date to cover the $5 processing fee.
Sign and date the form to authorize payment and agree to the terms stated.
Submit the completed form along with your Clipper card by mailing it to Clipper Customer Service at the provided address.

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