
| CORPORATE ACCOUNT INFORMATION: | |||||
|---|---|---|---|---|---|
| Company Name: | |||||
| Address * | Suite No. | ||||
| City * | State * | Postal Code | |||
| Telephone No. * | Extension | Fax | |||
| Federal Tax ID # | Estimated Monthly Usage | ||||
| AUTHORIZED OFFICER / OWNER / ADMIN | |||||
| NAME: | Title: | ||||
| Telephone No. | Email Address: | ||||
| CREDIT CARD INFORMATION REQUIRED: | |||||
| Credit Card No. | Exp Date | ||||
| Credit Card Holders Name: | CVV Code | ||||
| ACCOUNT TYPE | |||||
| Individual account personal check at end of billing cycle |
|||||
| Corporate check at end of billing cycle |
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| Corporate credit card on file | |||||
| Charge each individual employee credit card on file | |||||
| Billing Cycle |
|||||
| Weekly | Bi-Montly | Monthly | |||
| CORPORATE ACCOUNT INFORMATION: | |||||
| Last Name * | First Name * | Tel No. | |||
| Last Name * | First Name * | Tel No. | |||
| Enroll in World Club Rewards: | Yes | No | |||
| I have read and accept the Terms and Conditions of WorldLimo. If you decline, your transaction will be terminated. | |||||
| Accept | Decline | ||||