CORPORATE ACCOUNT APPLICATION

Company Information
Company Name *
Adress *
State *
Zip *
Phone *
Fax *
Web Site
Billing Contact Information
Bill Attention to *
Title
Extention Number
Cellular Phone
E-mail
Fax Number (if other)
Contact Information
Contact Name
Title
Extention Number
Fax Number (if other)
E-mail
Credit Card Information
Credit Card Type *
Credit Card Number *
Credit Card Exp Date *
Tax id Number *
Business Information
Nature Of Business
Trade Reference
Reference Contact Name
Reference Contact Number

This agreement is subject to the terms and
conditions appearing on this . No modifications or additions shall be binding upon.
Elie's Limo unless agreed to in writing.
Elie's Limo makes no warranty of any kind, express or implied, as to the service covered hereby except as provided on this agreement.
This order will become a contract only when
submit by customer with this form.

Accepted By

Name
E-Mail (Will send confirmation E-mail)
Date *
Sign