I have read the Lifeline Voucher Program information and understand BRAG is not responsible forreimbursements that do meet the program guidelines or if fraud is suspected.
Although BRAG encourages all drivers to have a valid license, vehicle registration, adequateinsurance, and to only provide transportation for trusted individuals; I understand I am liable for thetransportation I provide.
I verify the information I have provided on this form and the W9 is accurate to the best of myknowledge. I agree to update BRAG with any changes to this information and provide accurateinformation when submitting vouchers. I understand failure to do so may result in being removed fromthe program or legal action.