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BUSINESS INFORMATION: |
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| Business Name: |
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| Contact Name: |
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| Business Address: |
City: State: Zip: |
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| Mailing Address (*If
different): |
City: State:
Zip: |
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| Business Telephone: |
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| Fax: |
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| E-Mail Address: |
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| Legal Status of Business: |
Corporation
LLC
Partnership
Sole Proprietorship
Non-Profit
Organization
Government
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| Federal Tax I.D. Number: |
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| Are P.O. numbers required?
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Yes
No |
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BILLING INFORMATION: |
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Type of Account
Requested: |
Monthly billing and our company will
issue a check for payment within 30 days. |
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Monthly billing and I authorize you to
charge my CC at the end of the month for the whole amount. (complete CC#
information below): |
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I authorize you to bill my CC at the
end of each trip. (complete CC# information below): |
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| Credit Card Type: |
Visa
M/C
AMEX
DISCOVER |
| Name on Card: |
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| Credit Card #: |
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| Expiration Date: |
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Billing Zip Code: |
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CCV: |
(Credit Card Verification Number) |
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* Name(s)
of Personnel Authorized to Order Services: |
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(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(If needed, attach additional names of authorized personnel on
your company letterhead) |
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| LEGAL STATEMENT: In the event that this credit application
is approved, the applicant hereby agrees to and accepts the following
terms and conditions: FULL PAYMENT SHALL BE DUE UPON RECEIPT OF
STATEMENT. Failure to make payment in full within 30 DAYS of statement
closing date will subject applicants account to a finance charge, which
will be computed on the average daily balance at a monthly rate of 2%
(ANNUAL PERCENTAGE RATE OF 24%). In the event that the account remains
unpaid and legal fees therefore are incurred by Alta Limousine , to
obtain payment for services rendered or for information and assistance
Alta Limousine may require from whatever source it deems necessary to
obtain payment, the applicant shall be held accountable for all expenses
incurred in the collection process, including reasonable attorney fees.
The undersigned on behalf of the applicant authorizes Alta Limousine to
conduct a complete and thorough check of all the information supplied to
Alta Limousine. Furthermore, the applicant certifies that the above
statements are true, correct and complete and have been made by the
undersigned for the purpose of inducing Alta Limousine, to extend credit
to the applicant knowing that Alta Limousine, will rely thereupon,
furthermore the undersigned is fully aware of Alta Limousine's
cancellation, reservation and billing policies. |
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| Name of Person Preparing this document: |
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Title: |
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Initials: |
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Date: |
Thursday 20th of November 2008 02:39:43 AM |
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To submit, please enter the numbers you see in the image
below then click on SUBMIT APPLICATION:
AFTER YOU SUBMIT,
PLEASE WAIT A FEW SECONDS WHILE THE DATA IS PROCESSED |
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