First Responder Account Application

All first responders with an account and properly installed NC Quick Pass First Responder sticker are eligible for free travel on North Carolina toll roads while responding to emergencies for law enforcement, fire, rescue and medical services.

To apply, complete the First Responder Account Application below. An NC Quick Pass representative will review your submission and contact you regarding the next steps in the enrollment process.

All submitted information is subject to review and approval. Submission does not guarantee acceptance or eligibility.

First Responder Account Application

Profile

Agency Information

Agency Name(Required)

Primary Contact

Title

First Name(Required)

Last Name(Required)

County(Required)

Street Address(Required)

Address 2

City(Required)

State(Required)

Zip Code(Required)

Primary Phone(Required)

Phone Type(Required)

Alternate Phone

Phone Type

Email Address(Required)

Confirm Email Address(Required)

How would you like to receive statements?(Required)

Email (sent monthly)

Mail ($5.00 sent quarterly)

Personal Identification Number (PIN)(Required)

Provide a four-digit PIN to access your account using the automated telephone system. Please retain for your records.

Opt-in to receive text (SMS) account alerts from NC Quick Pass. Message and data rates may apply.(Required)

Yes, I want to receive text (SMS) account alerts from NC Quick Pass

No, I do not want to receive text (SMS) account alerts from NC Quick Pass

Message frequency varies depending on your account activity. Reply HELP for help or STOP to opt-out. View our Privacy Policy and SMS Disclosure

Do you have a secondary contact?(Required)

Yes

Secondary Contact

Title

Name

First Last

Email Address

Enter Email Confirm Email

Transponders & Vehicles

NC Quick Pass offers the free NC Quick Pass First Responder Sticker to fit your travel needs.

List license plate and vehicle information for each transponder being requested. You may not list more vehicles than the number of transponders you are requesting.*

The agency is responsible for keeping account and vehicle information CURRENT at all times.

Add vehicles below using the blue (+) symbol to the right.(Required)

License Plate Number

State

Make

Model

Year

Terms & Conditions

By signing below I agree to comply with the NC Quick Pass First Responder Account Terms & Conditions. The latest Terms & Conditions documents can be found at NC Quick Pass Documents and Applications or at request.

Customer Signature(Required)

Date(Required)

Comments

CAPTCHA