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Corporate Charge Account Application

Last Name........
First Name........Title:
Street Address:
City.....................State Zip
Co. Name.........Co. Street Address:
City....................
State................. Zip
Individuals Authorized To Use Services:(attach list if needed)
Work Phone..
Home Phone.
Cell Phone.....
Fax..................
E-Mail.............

*Gratuity Can Not be Included on Corporate Charge Account. Please Pay Gratuity Separately to Chauffeur (Suggested 15-20%).

*Unpaid Balances Due Within 14 Days. All Delinquent Accounts Will be Terminated.


Please use credit card information below for limousine service charges.

Name on Card...
Charge Card #...
Exp. Date............ 3-digit code (on back of card)

Card Type:

Master Card
Visa
Discover
American Express

Signature: _____________________________ Date: _________________

Please Print, Sign, and Submit form by fax to: 920-494-3840.