Learn more at ventrachicago.com or call 1.877.NOW.VENTRA. Page 1
NEW/REPLACEMENT INDIVIDUAL ORDER FORM –
PACE CAMPUS CONNECTION PASS
Use this form to request a new or replacement Ventra card for the Pace Campus Connection pass.
INSTRUCTIONS
This form is for those college and university students wishing to purchase a Pace Campus Connection pass,
and whose schools do not provide or administer College Ventra Cards and entitlements.
! College Ventra Cards and entitlements allow you to purchase the Pace Campus Connection pass.
! Please complete and mail this form with payment (if necessary) and proof of college/university
enrollment:
o If you need to purchase a new Card, complete Sections A and B
o If you already have a Card, complete Sections A and C
o If you need to purchase a replacement card, complete Section D
o If you’re a CTA College U-Pass holder, do not use this form, since you can already
purchase and add a Pace Campus Connection pass to your account at
ventrachicago.com, at Ventra retailers and, if registered, by calling 1.877.NOW.VENTR
A
(1.877.669.8368).
! Completing this form doesn’t automatically register you. If you register your card on the Ventra
website or by phone, transit value and passes are protected if the card is lost or stolen. Also, you’ll
be able to use convenient account management features – including loading value online or over
the phone – and for receiving important notifications and updates.
Section [A]!– Student Information
FIRST NAME _________________________________________________________________________ MIDDLE INITIAL _____
LAST NAME ______________________________________________________________________________________________
ADDRESS __________________________________________________________________________ APT./SUITE ___________
CITY ______________________________________________________ ZIP ____________ DATE OF BIRTH ____/_____/_____
Parent or Legal Guardian Information
FIRST NAME _________________________________________________________________________ MIDDLE INITIAL _____
LAST NAME ______________________________________________________________________________________________
(Address information, if different than student address:)
ADDRESS ________________________________________________________________________ APT./SUITE _____________
CITY ___________________________________________________________________ STATE _______ ZIP ________________
PRIMARY PHONE (______) ___________________ EMAIL _______________________________________________________
By signing, I indicate my agreement with the terms and conditions stated in the Ventra User Agreement
(available at ventrachicago.com).
STUDENT/PARENT/LEGAL GUARDIAN SIGNATURE _______________________________________ DATE ____ /____ /____