Shop-a-Round Application Registration Form

What are you applying for?

Shop-a-Round Van
Shop-a-Round Taxi
Both

Contact Information

First Name

Last Name

Date of Birth

Phone Number

Mailing address (including unit #)

City

State

Zip Code

Senior Clipper Card

Do you have a Senior Clipper Card?

Yes
No

Senior Clipper Card

Clipper Serial Number*

10 digit number printed on the back of your Clipper Card.

Re-enter Clipper Serial Number*

RTC Card

Do you have a RTC Card?

Yes
No

RTC Card

RTC Card Serial Number*

8 digit code printed on the front of your RTC Card.

Re-enter RTC card serial number*

San Franscisco Paratransit Id

Do you have an SF Paratransit Id Number?

Yes
No

SF Paratransit Id Number

SF Paratransit Id Number*

Re-enter SF Paratransit Id Number*

SF Paratransit Services

Learn more about SF Paratranit services

Proof of Age or Disability

Applying without a Senior Clipper Card, RTC Card, or SF Paratransit Id will take 7-14 days for us to process your request and requires upload of a photocopy or picture of one of the following:

Photo Id

State Issued ID Card or Driver's License
SF City ID Card
Birth Certificate
Alien Registration/Permanent Resident Card
Passport

And any one of the following:

Medicare card, the federally-issued red, white, and blue card - only for those under 65 years of age. (NOTE: Medi-cal is not accepted for eligibility.)
California DMV Placard Registration parking placard receipt.
Other California transit agency card that is equivalent to the RTC Card.
Proof of Veterans Disability -- A copy of your Service Connected Disability ID card.

Both name and age must be visible in the attached images.
All documents will be deleted from our system once your application is reviewed.

Upload Proof of Age or Disability Document

*Uploaded file must be less than 20 MB. File types are restricted to Microsoft Office file type, jpg, png, and pdf.

Mobility

Do you use a mobility aid (for example, wheelchair, walker, etc.)?

Yes
No

Language

Primary Language

Requirement Clause

By submitting this form you (1) attest the information provided is true and accurate and (2) understand the SFMTA may conduct audits, and (3) if requested, you will be required to provide documentation proving income level.

Failure to respond will result in termination from the program and/or administrative fines.

I agree to the requirements above

Yes

Shop-a-Round Application Registration Form

Apply Online:

Download and Submit Registration Form: