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CREDIT APPLICATION/CREDIT CARD AUTHORIZATION

Company Name *

Email *

Address *

City *

State *

Telephone *

Zip Code *

Owner/Officer(s) and SS# *

Authorized To Bookers *

Referred By *

CREDIT CARD INFORMATION

Must be accompanied by photocopy of a picture I.D. and a copy of front & back of card. AMEX M/C VISA DISC DINER’S Account number:

Cardholders Name *

DIRECT BILL ACCOUNT

Only to be filled out if you are requesting to be billed. All accounts must fill out credit card info.

Bank Name *

Telephone Number *

Account Number *

Fax *

Trade References (Do not use CPAs, landlords or utility companies)

Name *

Telephone *

Address *

Authorized Signature on Account *

Print Name *

Application must be filled out completely for a direct bill account. For a credit card account only the top portion and the authorized signature need to be filled out. On direct bill accounts the credit card will be used only if a charge is delinquent more than ninety days. Applicant agrees to alphalimogroup Limousine, Inc. Terms, Conditions, and Rates.

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