Date: ___________

Please Mail the Bid/Solicitation package (s) listed above to me:

COMPANY NAME: ________________________________________________
ADDRESS:______________________________________________________ _______________________________________________________________
ATTENTION: ______________________ TITLE:________________________
PHONE: __________________________ FAX: _________________________
EMAIL: ___________________________ DUNS # : ______________________

Note: Please provide a street address when filling out this form, Post Office box addresses are unacceptable.

PAYMENT:

All document fees are payable to the Triborough Bridge And Tunnel Authority by Company or Certified check or money order (checks for $350 and over must be certified), Visa, Mastercard, American Express or ATM cards. Personal checks will not be accepted. Cash or ATM cards can not be accommodated via mail. There are no refunds given.

CREDIT CARD: (CHECK ONE) OR COMPANY/BANK CHECK #: _________
VISA ____
MASTERCARD ____
AMERICAN EXPRESS ____
ACCOUNT #: ______________________________ EXPIRATION DATE:________
SIGNATURE: _________________________________________

OVERNIGHT COURIER ____________________________ ACCOUNT # _______________________
(Documents will be mailed US Postal service regular mail if overnight courier information is not provided).