PERSONAL CREDIT APPLICATION

Personel Information

Name *

Adress *

State *

Zip *

Phone *

Fax *

Web Site

Cellular Phone

Billing Information (if other)

Bill Attention Name (if other)

Phone

E-Mail

1.Credit Card Information

Credit Card Type *

Credit Card Number *

Credit Card Exp Date *

Credit Card Holder Name*

2.Credit Card Information

Credit Card Type

Credit Card Number

Credit Card Exp Date

Credit Card Holder Name

THE ABOVE CREDIT CARD(S) # WILL BE KEPT ON FILE. EACH WEEK CHARGES WILL BE AUTOMATICALLY DEDUCTED FROM YOUR CREDIT CARD. A COPY OF YOUR INVOICE WILL BE SENT FOR YOUR REVIEW.

AUTHORIZATION IS GIVEN TO ELIE'S LIMOU TO OBTAIN AND VERIFY ABOVE INFORMATION. ELIE'S LIMO RESERVES THE RIGHT TO REFUSE SERVICE TO ANY ONE WHO IS IN ARREARS. OUR TERMS NET 10 DAYS. ALL RIDES WILL BE CHARGED AN ADDITIONAL $ 2.OO PROCESSING FEE.

Must All Passengers Have a Vip Card or a Voucher ?

Anyone With a Vip Card Can Order a Car Without Showing The Vip Card to The Driver?

PLEASE LIST ALL VIP CARD NAMES AND HOW MANY VOUCHERS YOU WOULD LIKE TO START WITH.

VIP NAME1

VIP NAME2

VIP NAME3

VIP NAME4

VOUCHERS

Date *

Sign (Type Your Name)