Vanpool Participant Withdrawal Form

Vanpool Participant Withdrawal Form
As much as we hate to see you go, you may withdraw from a Pierce Transit vanpool at any time.

There are two steps:

1) Complete and submit this form. (You will receive an email confirming your choice to withdraw from your vanpool group.)

2) Provide a copy of the withdrawal confirmation email to your vanpool bookkeeper by the 20th of the month.

Your Vanpool Participant Agreement and monthly fare will remain in effect until both steps are complete.

Thank you for choosing to commute with Pierce Transit!
Name *

First Name Last Name
Email *
I am withdrawing from vanpool group number: *
Today's date: *

Month Day Year
Date
My last day on the van will be: *

Month Day Year
Name of your group's Primary Driver or Bookkeeper: *
Reason for withdrawing: *

Shift change Retiring Unresolved vanpool issues Transferring to different Pierce Transit vanpool Transferring to another agency
Which Pierce Transit vanpool group are you transferring to? *
Please list vanpool group identification number.
When are you starting with your new vanpool group? *

Month Day Year
Which transit agency are you transferring to? *
Please list the name of the transit agency you will be commuting with.
After signing with DocuSign, please click the green Submit button below.
Should be Empty: