CDC Passenger Fare Card Primary Card User(Required) First Last Address(Required) Street Address Address Line 2 City State Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Are you completing application on behalf of a student?(Required) Yes No School Attending(Required) Date of Birth(Required) DD slash MM slash YYYY Grade(Required) Gender(Required) Male Female Contact Phone Number(Required)Email(Required) Routes Frequently Travelled on(Required) Will the card be used by multiple passengers(Required) Yes No Additional User 1Additional User Name(Required) First Last School Attending(Required) Date of Birth(Required) DD slash MM slash YYYY Grade(Required) Gender(Required) Male Female Additional User 2Additional User Name(Required) First Last School Attending(Required) Date of Birth(Required) DD slash MM slash YYYY Grade(Required) Gender(Required) Male Female Additional User 3Additional User Name(Required) First Last School Attending(Required) Date of Birth(Required) DD slash MM slash YYYY Grade(Required) Gender(Required) Male Female Additional User 4Additional User Name(Required) First Last School Attending(Required) Date of Birth(Required) DD slash MM slash YYYY Grade(Required) Gender(Required) Male Female Card Fee Price: Initial Recharge Amount(Required) Total Amount Payable Consent(Required)This Passenger Fare Card can only be used on CDC Gladstone bus services. This card remains the property of CDC Gladstone. I agree to ensure that the card has sufficient funds to cover the passenger’s bus fares at all times. Failure to do so may result in suspension from bus services. If the Passenger Fare Card is misplaced, stolen or damaged, it can be ‘blacklisted’ to prevent anyone else from accessing the money on the card. The balance can then be transferred to a new card. In order to purchase a new card and recover the funds I agree to notify CDC Gladstone and pay the $10.00 card fee to purchase a new card. If I no longer want or need the Passenger Fare Card, I can request a refund of the remaining card balance. I also have the option of transferring the balance to another Passenger Fare Card. N.B. These cards have fine copper wires running through the inside. Once these copper wires are damaged the card will not work. Do not hole punch, cut, bend, pierce, bite/ chew on the card. It is the passenger’s responsibility to ensure the card is stored securely to prevent any unnecessary wear and tear. I agree to the Terms & Conditions.
