Safe Rides Cash Back Form

Please have the following items ready.

1. Sac State One Card 2. A copy of the receipt. The receipt must show the date of service (within the current semester) and proof of payment. 3. Debit or credit card you used to make the payment. Apple Pay, Google Pay, Pay Pal, pre-paid cards, cash, and other payment methods are not eligible for Safe Rides.

Safe Rides Cash Back Form

Hello Hornet! Complete the following form to request cash back for an eligible rideshare trip, SMOG check or vehicle safety inspection. The last day to submit a Safe Rides cash back form for the Fall 2023 semester is December 12th .
Student Information
Name*

First NameLast Name
Sac State Email Address*
Please enter a valid @csus email address
Student ID Number*
Upload One Card (Student ID Card) Image*

Please upload an image of your current Sac State student One Card.
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Mail or hold cash back check for pickup?*

Mail my check
Approved Reimbursement Amount
MAILING ADDRESS

Please enter below your mailing address that is accurate as of Fall 2023. To avoid delays, accurately enter your full address, including apartment, (room and side letter if on campus housing) or unit number if applicable.
*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What type of service are you requesting cash back?*

Rideshare service (Uber, Lyft, taxi rides)Vehicle Safety Inspection (SMOG checks, vehicle safety inspections)

Trip Details

Enter in the following details about your rideshare trip below. Payment on the receipt must be paid originally by the Sac State student requesting cashback. Payment on the receipt must be a valid debit/credit card issued in the student's name. Apple Pay, Google Pay, PayPal, pre-paid cards, cash and other payment methods are not eligible for Safe Rides reimbursement.
Debit/Credit Card Image*

Upload an image of your debit or credit card that was used to pay for your rideshare trip. Please block out the first 12 numbers on the card, leaving only the last four digits showing on the image. The debit/credit card must be issued in your name.
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Upload Rideshare Trip Receipt*

Upload a rideshare trip receipt. Receipt must show trip route, a date that is within the current semester, total cost of trip and the last 4 digits of your debit/credit card. Trip receipts are typically available in your rideshare app or emailed to you after the ride. If you need help finding receipts, reach out to us. You may upload up to two rideshare receipts per Safe Rides cash back request form.
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Vehicle Safety Inspection Details

Enter in the following details about your receipt below.
Debit/Credit Card Image*

Upload an image of your debit or credit card that was used to pay for your rideshare trip. Please block out the first 12 numbers on the card, leaving only the last four digits showing on the image. The debit/credit card must be issued in your name.
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Upload SMOG or Vehicle Safety Inspection Receipt/Invoice*

Upload a vehicle safety inspection receipt/invoice. Receipt must be dated within the current semester. It must also include the name of the business, the type of service performed (SMOG or inspection service), total cost including tax and the last 4 digits of your debit/credit card.
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Please have the following items ready.