PLEASE PRINT OR TYPE INFORMATION Date:
SOLICITATION NUMBER/DESCRIPTION |
QUANTITY |
PRICE |
TOTAL |
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Please Mail the Bid/Solicitation package (s) listed above to:
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 check, Money Order, Visa, MasterCard, or American Express. Personal checks will not be accepted. ATM cards can not be accommodated via mail. Cash is not accepted. There are no refunds given.
CREDIT CARD: (CHECK ONE) OR COMPANY/BANK CHECK #: ____________________
____ VISA ____ MASTERCARD ____ AMERICAN EXPRESS CVV CODE _______________________
(3 DIGIT CODE ON BACK OF VISA/MASTERCARD OR 4 DIGIT CODE ON FRONT 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).
MAIL OR FAX THIS FORM TO:
MTA BRIDGES AND TUNNELS
2 Broadway – 23rd Floor
NEW YORK, NY 10004
ATTENTION: Procurement Administration
FAX: 646-252-7077
PHONE: 646-252-7092/7147
(E-Mail Questions: VProcure@MTABT.org )
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