Form Builder

Type of change

Contact information
Type of pass
Financial institution

Current contact information

Gender

Mr
Mrs
Other

If Other

First name

Last name

Year of birth

4 digits

FIDELITE Multi card number

16 digits

Address

Apt no.

City

Postal code

The postal code must be in the following format: X0X 0X0

Telephone

The telephone number must be in the following format: 111 111-1111

New contact information

Address

Apt

City

Postal code

Telephone

Note date - type 1

Veuillez indiquer la date souhaitée d’entrée en vigueur des changements:

Please indicate the date these changes becomes effective:

Month

Year

Type of pass change

Type of change

Regular to senior fare
Regular to ECHO fare
ECHO to Regular fare

Note pour les ainés

65 ans et plus (preuve d'âge requise)

65 years and over (proof of age required)

Note Echo

Conditionnel à l'éligibilité

Conditional to eligibility

Note date - option 2

Veuillez indiquer la date souhaitée d’entrée en vigueur des changements:

Please indicate the desired start date of the change:

Month

Year

Please indicate the service point where you wish to pick up you Multi card

Financial institution change

financial change not

Faites-nous parvenir ce formulaire dûment rempli ET un nouveau spécimen de chèque avec la mention « ANNULÉ » au plus tard le 15ième jour du mois pour que le changement soit effectif au prochain prélèvement bancaire.

You must send the STO a new sample check marked VOID, along with this duly completed form, by the 15th day of the month so that processing can be completed for the next debit date.

note_date_type_3

Veuillez indiquer la date souhaitée d’entrée en vigueur du nouveau compte bancaire

Please indicate the date that the new bank account becomes effective:

Month

Year

I am including a sample cheque marked VOID for the account to be debited.

Document

5 Mb
pdf jpg jpeg png

I authorize my financial institution to process a debit on my account for all amounts ordered by the Société de transport de l’Outaouais, for as long as my pass remains active.

Member authorization

I authorize the STO to proceed with the changes requested in this form

Bottom form note

Pour plus d’information, écrivez au fidelite@sto.ca ou contactez le 819 770-3242.

For more information, please write to fidelite@sto.ca or call 819 770-3242.