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Application for Reduced Fare

  1. RoadRUNNER Two Color Logo

  2. APPLICATION FOR REDUCED FARE

  3. RoadRUNNER offers half fare to persons with disabilities, Medicare recipients, and senior citizens age 60 and older. Half fare is available on RoadRUNNER’s fixed-route service. Persons with disabilities must have a valid I.D. card issued by RoadRUNNER or other public transportation system. The information obtained in this application will only be used to determine your eligibility for RoadRUNNER’s Reduced Fare Program. Please complete the following:

  4. The person named below is familiar with my condition or disability and is authorized to provide information required to verify my disability status:

  5. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  6. SENIOR CITIZENS: Proof of age (60 years or older) or Medicare Card required.

  7. CERTIFICATION

  8. I certify that according to my (check those that apply)

  9. The disability is

  10. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  11. This application can be made available in alternative formats by calling (575) 541-2500

  12. Leave This Blank:

  13. This field is not part of the form submission.