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 Angela Ramsey at 718-694-4707.

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 Email

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 Email

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.)
$5 Gold MetroCard (50 cards per Batch) @ $250 per batch
$5 MetroCard Air Train (50 cards per Batch) @ $250 per batch
$9.52 Bonus MetroCard (50 cards per Batch) @ $476 per batch
$19.05 Bonus MetroCard (50 cards per Batch) @ $952.50 per batch
$25 10-Trip AirTrain MetroCard (10 cards per Batch) @ $250 per batch
$30 7-day Unlimited Pass (50 cards per Batch) @ $1,500 per batch
$40 30-day Air Train (10 cards per Batch) @ $400 per batch
$38.10 Bonus MetroCard (25 cards per Batch) @ $952.50 per batch
$55 7-day Express Bus Plus (25 cards per Batch) @ $1,375 per batch
$57.14 Bonus MetroCard (10 cards per Batch) @ $571.40 per batch
$112 30-day Unlimited Pass (10 cards per Batch) @ $1,120 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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