PLEASE NOTE: After completing this Application, the MetroCard Contract, and the Release Authorization Form,
Print and fax the completed forms to 646-252-6599, or mail them to:
Check all that apply:
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Principal(s) Operate/Manage Business?
Current Home Address
The statements I/we have made in the Application & Contract are true. I/we agree to notify
MTA New York City Transit (MTA NYCT) of any important changes in the facts listed above supplied
by Merchant within 7 days. Merchant understands that he/she is fully responsible for all information
on this Application & Contract and that all such information is true and complete. The application now
belongs to MTA NYCT. I/we further understand that a Consumer Report of each of the
officers/partners/proprietor/owner of the applicant firm may be requested from a Consumer Reporting
Agency. A Consumer Report is a routine report on credit worthiness frequently used by creditors. If
the Application is approved, subsequent Credit Reports may be required or used in connection with the
maintenance, updating, renewal, or extension of the Contract. I/we agree that all business references,
including banks, may release any and all credit and financial information to MTA NYCT. I/we agree and
acknowledge that the information provided in this application and other relevant credit data may be supplied
to MTA NYCT and their affiliates. Any unilateral alteration, strikeover, or modification to the preprinted text or
line entries of the Application & Contract shall be no effect whatsoever, and at MTA NYCTís sole discretion,
may render this Agreement invalid.
Are you involved in any litigation that might affect the stability of your business?
By signing this Application & Contract I acknowledge that I wish to become a MetroCard Sales Merchant for
MTA NYC Transit. I understand that I am not authorized to sell MetroCards until I receive notification of acceptance
as an Merchant from MTA NYC Transit at which time I shall be subject to the terms of the Application & Contract.
It is not necessary to employ any person, agency, or organization to assist you in filing this application. Beware
of persons claiming to be able to assist you in securing action on your application. The payment of money or
other things of value for the use of influence, or the promise of influence, to become a MetroCard sales Merchant
is a violation of law and offenders will be prosecuted.
PLEASE NOTE: After completing this Application, the MetroCard Contract, and the Release Authorization Form, print and fax the completed forms to 646-252-6599, or mail them to:
MTA NYC Transit
2 Broadway, 10th Floor
New York, NY 10004
You have completed 1 of 3 required forms for the application.