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Corporate Account Application
Company Name:
Your Name:
Street Address:
State / Zip code:
E-Mail:
Contact Person:
Federal ID #:
Telephone #:
Fax #:
Names and Title of Authorized Users
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2:
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6:
Payment Information
Credit Card #:
Name as it appears on Card:
Expiration Date:
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2006
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Type:
American Express
Discover Card
Master Card
Visa Card
Typed Signature:
Invoice amount is due upon receipt. We can bill your Credit Card directly or, you can pay by Company Check. Payment not received within 30 days of the invoice date will be charged to provided Credit Card with 8% processing fee .Thank You for selecting A&A Limo Service. If you hav e any questions please contact our billing department.
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