Corporate Account Application Form Toll Free: 844-855-7433 Local: 631-451-7433
Website: www.limorideline.com email: info@limorideline.com
BUSINESS INFORMATION:
Legal Name of Business: _____________________________________________ Doing Business As: _____________________________________
Type of Business:
Corporation ____ Partnership ____ LLC ____ Sole Proprietor ____
State of Incorporation: ______ Date of Incorporation: ________________ Federal Tax ID#: _______________________
Billing Address : ____________________________________________________ City: _________________ State: ________ Zip: _________
Business Phone: ___________________ Business Fax: ___________________
Applicant Name : _______________________ Ext: ___________________ Email address: ________________________________
TERMS OF PAYMENT:
Credit Card Type: Visa □ AMEX □ MasterCard □
Name on Card : ______________________________________________________ Credit Card No: _______________________________________
CVV: _________ Expiration Date: ______________
(Please provide us with a copy of the front and back of the Credit Card.)
Names Of Personnel Authorized To Request Service:
Full Name: _________________________________ Phone Number: ___________________
Full Name: _________________________________ Phone Number: ___________________
Full Name: _________________________________ Phone Number: ___________________
By signing this form below, the Company acknowledges and agrees to pay for any and all charges invoiced to the company by Rideline. The authorizer hereby warrants and represents he/she has the authority to legally bind the Company as set forth herein. Being the cardholder or Corporate Officer, by signing below I understand and agree to the terms set forth in this agreement, agree to pay, and specifically authorize Rideline Car and Limo Service (“Rideline”) to charge my credit card, for the transportation services provided. Rideline will provide me with an itemized statement detailing all of my charges. I further agree that in the event my credit card becomes invalid, I will provide Rideline with a new valid credit card upon request, to be charged for the payment of any outstanding balances owed to Rideline. If the Company listed above fails to pay, I personally guarantee payment of all obligations the Company may owe to Rideline printed.
Name: __________________________________ Signature: ______________________________________
Official Corporate Title: __________________________ Date: ___________________