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

Credit Card Purchase Application

PLEASE NOTE: After Completing the Credit Card Application,
complete the MetroCard Merchant Sales Agreement Contract (PDF file, 50K).
Print, Sign and Fax both forms to (Secure) Fax # 718-694-1686.

For Additional information, please call Natasha L Williams at 718-694-1664.

Date
Sales Rep Signature: _____________________________________________________

Billing Information:

Please Check One: Residential Business

Company Name
Address 1
Address 2
City State Zip
Country
Contact Name
Telephone Fax

Shipping Information:

(Complete if different than billing information)

Please Check One: Residential Business

Company Name
Address 1
Address 2
City State Zip
Country
Contact Name
Telephone

Credit Card Information:

Credit Card Type: MasterCard Visa American Express Discover
Credit Card Number
Expiration Date
Card Holder's Phone #
Credit Card Holder
Credit Card Address
City
State
Zip
Country

MetroCard Order:

Please Enter the Number of Batches Ordering	TOTAL (Please Calculate Totals Manually.)
$4.50 Gold MetroCard (50 cards per Batch) @ $225 per batch
$5 MetroCard Air Train (50 cards per Batch) @ $250 per batch
$10.51 Bonus MetroCard (50 cards per Batch) @ $525.50 per batch
$21.03 Bonus MetroCard (50 cards per Batch) @ $1,051.50 per batch
$25 10-Trip AirTrain MetroCard (10 cards per Batch) @ $250 per batch
$29 7-day Unlimited Pass (50 cards per Batch) @ $1,450 per batch
$40 30-day Air Train (10 cards per Batch) @ $400 per batch
$42.06 Bonus MetroCard (25 cards per Batch) @ $1,051.50 per batch
$50 7-day Express Bus Plus (25 cards per Batch) @ $1,250 per batch
$51.40 Bonus MetroCard (10 cards per Batch) @ $514 per batch
$104 30-day Unlimited Pass (10 cards per Batch) @ $1,040 per batch
Total Cost:

PLEASE NOTE: After Completing the Credit Card Application,
complete the MetroCard Merchant Sales Agreement Contract (PDF file, 50K).
Print, Sign and Fax both forms to (Secure) Fax # 718-694-1686.

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