MyACCESSRide.com

ePurse ENROLLMENT FORM | REVISED 10/19

ePurse ENROLLMENT FORM

Name:

_________________________________________

___________________

Last

First

ACCESS ID Number

Address

: ___________________________________________

Apt: #____________

City

___________________________________

State

____________

Zip

___________

Phone

:

Home ____________________Work_______________________________

Cell______________________ Email_______________________________

Setting up your Personal ePurse Account

1. Select your PIN for your ePurse

It must be numeric and at least 4 digits and not more than 8 digits __________

2. Choose a secret question.

Write your answer next to the one you selected.

Please choose only one of the following questions.

•

What is the month and year of your mother’s birth? (ex. 01/1932) ___________

•

Name of the city where you were born? _______________________________

•

What is your mother’s maiden name? _________________________________

•

Who was your childhood hero? ______________________________________

3. Record your answers in a safe place for your future use.

You will need your PIN to

use your ePurse and to schedule your ACCESS trips.

4. Return the completed form to: ACCESS Transportation Systems, 650 Smithfield St.

Suite 440., Pittsburgh, PA

15222.