Commercial Account Travel History

COMMERCIAL ACCOUNT TRAVEL HISTORY RELEASE

I hereby grant permission to the South Norfolk Jordan Bridge to conduct an account review of our company’s Virginia E-ZPass vehicle travel usage for the purpose of potential travel rate volume discounts or travel incentive considerations.

The SNJB certifies the following:

1) It will only access this information for this purpose and will not have access to the user’s financial or personal information.

2) All Virginia E-ZPass vehicle travel usage information compiled will remain confidential.

Virginia E-ZPass Account Name:*
Virginia E-ZPass Account Number:*
Company*
Name*
First Last
Email*
Title
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
CAPTCHA