Application for MTA Discount Listing

*Indicates required field
* I have read the Guidelines for Discount Listing in the MTA Benefits & Discount Directory and certify the discount stated below complies with these guidelines.
If you currently participate in this program, enter the ID number and company name as it appears on your current discount agreement, and click “Prefill Form”. Your information will automatically fill in.
* Does your company have multiple locations?
Submit a separate form for each individual location.
ID Number:
Category:*
Company Name:*
Street:
City:
State:  Zip:
Massachusetts County:
Phone Number:
E-mail:
Web site:
Discount copy as it will appear
in the directory (subject to
editorial review):*

Enter the contact person's information below.
Last Name:*
First Name:*
Phone Number:*
E-mail:*
Title:*
Is the contact person's mailing
address different from the
directory listing?
If the mailing address is different, enter it below.
Company Name:
Street:
City:
State:  Zip:
The above-named individual approves the discount displayed above and assures that it is accurate and will be honored in accordance with the Guidelines for Discount Listing in the MTA Benefits & Discount Directory. This discount will appear in an MTA directory, online and in other MTAB publications.
 
Contact Person's Name:*
Forms that do not have all the required areas filled in (those indicated by an asterisk) will not be processed.