| Account ID | _____________________________________________________ |
| Company Name | _____________________________________________________ |
| Contact Name | _____________________________________________________ |
| Phone Number | _____________________________________________________ |
| Fax Number | _____________________________________________________ |
| E-Mail Address | _____________________________________________________ |
| Your Card Details: | |
| Card Type | Amex Discover Master Card Visa |
| Expires | _____________________________________________________ |
| Account # | _____________________________________________________ |
| Name on Card | _____________________________________________________ |
| Credit Card Billing Address |
_____________________________________________________ _____________________________________________________ _____________________________________________________ |
| Agreement & consenting authorization: | |
|
I , ____________________________________ , OF ____________________________________ , |
|
|
authorize AllLimos (charge name Airport Commuter) to
charge my credit card on a monthly basis, for charges my account acquires
based on the lead quotations I receive from AllLimos advertising and referral service. I
understand that this account can be cancelled at anytime, provided that
express written notice is given by faxing: +1-650-976-1779. I understand that I am liable for all fees up
until the cancellation date. I have read and understand the All Limos Nationwide Limo Service
Terms of Service. Terms
of service: Welcome! With your membership now, you can avoid any set-up charges, and get all the benefits of membership with no annual fee, please note that you can cancel your account at any time. I accept the above Agreement & consenting authorization.
Name ____________________________ Signature : ____________________________ |
|