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Application

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:

MetroCard Sales
MTA NYC Transit
2 Broadway, 10th Floor
New York, NY 10004

Date
MetroCard Merchant Non-Selling Location/Employer Source_____________
NYC Agency Non-Profit/Government Agency Sales Rep___________


About Your Business
Company Name
Doing Business As
Contact Title
Address
City State Zip
Phone Fax
Number of Outlets Business Began (mo/yr)
Tax ID Number Borough/County

Check all that apply:
Sole proprietor
Partnership
Public corporation
Franchise
Nonprofit/government
Private corporation State

Business Hours
Sun:   from to
Mon:   from to
Tues:   from to
Wed:   from to
Thu:   from to
Fri:   from to
Sat:   from to


Sales Information
Products/services sold
Annual sales of business (cash and credit)
Average number of customers per week

Check all that apply:
Sell lottery tickets - on-line/instant
Advertise locally
Accept Credit:
    Amex
    Visa
    MasterCard
    Discover

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Information About Proposed MetroCard Sales Locations
  1. Number of proposed locations
  2. Address of each location (Attach as a separate sheet)

  3. Please complete the following:

    1. Subway station & routes (s)
    2. Bus stop & route(s) (specify if NYCT or private):

    3. Nearest intersection
      MTA's priority area code
    4. Neighborhood

    5. Zoning:

    6. Location:
      if other please specify
    7. Business Type:

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Supplier References
  1. Business Name
    Product/Service Purchased
    Contact Account Number
    City State Zip Phone

  2. Business Name
    Product/Service Purchased
    Contact Account Number
    City State Zip Phone

  3. Business Name
    Product/Service Purchased
    Contact Account Number
    City State Zip Phone


Property Ownership
Business premises are:

If rented, please complete:
Landlord Business Name
Contact
Address
City State Zip
Phone
Renting Since Monthly Rent Lease Expires On


Principal Information
Please list all partners and principals. For
publicly traded corporations list officers and directors and
those holding 10% or more of ownership interest.

Principal(s) Operate/Manage Business?

  1. Officer Name Title
    Current Home Address Phone
    City State Zip

  2. Officer Name Title
    Current Home Address Phone
    City State Zip


Application Terms

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: AN APPLICATION IS NOT COMPLETE UNLESS IT INCLUDES THE FOLLOWING ITEMS:
    • VOIDED CHECK
    • SIGNED CONTRACT
    • RELEASE AUTHORIZATION FORM

PLEASE NOTE: After completing this Application, the MetroCard Contract, and the Release Authorization Form,
Print and fax the completed forms to 718-694-1686, or mail them to:

MetroCard Sales
MTA NYC Transit
130 Livingston Street 5th Floor
Brooklyn, NY 11201

 
You have completed 1 of 3 required forms for the application.


Click here to go to MetroCard Contract (PDF file, 50K)
Click here to go to Release Authorization Form
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