NYU NYUCard > Forms > Merchant Application

If you are interested in participating in the NYU Campus Cash Program, please complete this application first Merchant Application.

If you prefer to fill your form out offline, please download a PDF version.

Note: All fields are required.

Date:
Legal Business Name:
DBA Name:
Address:
City:
State:
Zip:
Business Phone:	( ) -
Fax No.:	( ) -
Business Email:
Owner Name and Title:
Owner Address:
Phone Number:	( ) -
Number of Years in Business:
Billing Contact Name:
Phone:	( ) -
Remit Payment to Address:
Federal Tax ID Number:
Product/Service Providing:
Business Classification:	Small Business
	Minority
	Woman Owned Business
	Normal

Note: Owner must be present to sign the legal agreement.