Bus Pass Application Form 2019

Order your bus pass now for (1 September 2019 to 31 July 2020) by completing the form below or giving us a call on 01283 500 228

Name of Passenger *

First Name Last Name

Date of Birth of Passenger *

Day Month Year

Establishment

Bus route used (for info – pass can be used on any route) . *

Address

Street Address
Street Address Line 2
City	County
Post Code	Country

My Products

Term - 5-18 (Not valid to Rodbaston College) £ 150.00 GBP

Term - Student 19+ (Not valid to Rodbaston College) £ 175.00 GBP

Term - Rodbaston College £ 225.00 GBP

Annual - 5-18 (1 September to 31 July 2020) (Not valid to Rodbaston College) £ 395.00 GBP

Annual - Student 19+ (12 months from date of issue) (Not valid to Rodbaston College) £ 494.00 GBP

Annual - Adult (12 months from date of issue) £ 600.00 GBP

Total £ 0.00 GBP

Pass entitles the holder to unlimited travel on all buses operated by Midland Classic including weekends and school holidays within its validity.

Passes will be posted to the address above.

Photographic ID (passport style photograph) needs to be provided by jpg, jpeg, png image *

Proof of eligibility

For Student 5-18 passes please provide proof of age (needs to be provided by jpg, png, jpeg, image or pdf), for Student passes 19+ please provide student ID (needs to be provided by jpg, png, jpeg, image or pdf)

Payment

By cheque, payable to Midland Classic Ltd By bank transfer. Nat West 52-10-35 14587815 (please put child’s name in the reference box) By cash at our garage by appointment, Wetmore Road, Burton upon Trent, DE14 1QL

Terms & conditions

Bus pass is not transferable and can only be used by the person it is issued to.
Free travel available on all local bus services operated by Midland Classic at any time of day.
Any fraudulent or attempted fraudulent use of pass may result in it being withdrawn immediately without refund.
Holders are carried in accordance with our standard conditions of carriage.
Children under 5 do not travel free when accompanied by holders of the pass.
Holders of the pass get no priority over and above other passengers.
Lost or damaged bus passes will be replaced at a cost of £25.

Full conditions of carriage are on our website.
Please see our Privacy statement on the website for how we handle your
data

Full Name of Person Ordering *

First Name Last Name

Email of Person Ordering *

example@example.com

Phone Number of Person Ordering *

Area Code Phone Number

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