E-ZPass MA Customer Service Center
27 Midstate Drive
Auburn, Massachusetts 01501-1839
1-877-627-7745
1-508-786-5222 (Fax)
www.mass.gov/ezpassma
ADDITIONAL TRANSPONDER REQUEST
Account Number: ______________________
Last Name: ___________________________
First Name: _____________________________
Street Address: _________________________________________________________________
City: _________________________________
State: ___________ Zip: __________________
Home Telephone: ______________________
Cell Telephone:
_________________________
Number of additional transponders requested: _____Interior; _____ Exterior
License Plate/Vehicle Information:
License Plate
State
Plate Type
Make
Model
Year
1. _________________ ______ ___________ _________________ ________________ ________
2. _________________ ______ ___________ _________________ ________________ ________
3. _________________ ______ ___________ _________________ ________________ ________
Trailer / Camper Information:
Yes
No
Are you requesting a transponder for a vehicle towing a trailer or camper?
Are you requesting a transponder for a self-propelled motor home or camper?
If you answered ‘Yes’ to either of the above questions, please provide the following additional detail about
your camper(s) / trailer(s).
Total Number Dual Tires
of Axles (incl. (Yes/No)
vehicle towed)
Under 7,000 lbs
(Yes/No)
Under 7’6” in height
at second axle
(Yes/No)
Hitch Type (if any)
(Standard Hitch or
th
5 -wheel)
___________
________
____________
________________
_______________
___________
________
____________
________________
_______________
Signature ____________________________________________ Date _____-______-_____
E-ZPass MA USE ONLY:
Transponder numbers issued: ___________
11/14
___________
___________