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On Request by:
MetroCard Retail Sales

2 Broadway, 10th Floor
New York, NY 10004
Phone # 888-345-3882    Fax # 646-252-6599

BANK ACCOUNT INFORMATION RELEASE AUTHORIZATION FOR METROCARD MERCHANT APPLICANTS
Date
To Whom It May Concern,
I,
of (Company Name), herein authorizes,
(Name of Bank)
(Address)
Bank Phone # Bank Contact Person
to release to a duly authorized representative of the New York City TRANSIT Metrocard RETAIL Sales a duly authorized representative of the MTA NYC Transit, MetroCard Retail Sales program, any information requested in respect to my account(s) for Official Use by the New York City Transit Authority. Should there be any questions as to the validity of this release, you may contact me directly.
Account Number:
Routing Number:
Signature: ___________________________________________
Telephone:
Please Attach a copy of a Voided Check

You have completed 1 of 3 required forms for the application.
Click here to go to MetroCard Application
Click here to go to MetroCard Contract (PDF file, 50K)
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