Please enter your company's information in the form below
* Legal Name of Business:
Doing Business as:
Type of Business:
Date of Incorporation:
State of Incorporation:
* Federal Tax ID Number:
Email Address:
* Mailing Address:
* City/State/Zip:      
* Business Phone:
Business Fax:
Applicant Name:
Extension
   
Names of Personnel authorized to request service
Full Name: Ext:
Full Name: Ext:
Full Name: Ext:
Full Name: Ext:
Full Name: Ext:
Full Name: Ext:
Please enter additional names in the comments field below.
   

Terms and Conditions (Please review the below listed terms and conditions)

The below listed applicant hereby agrees to and accepts the following terms and conditions: FULL PAYMENT OF ALL INVOICES ARE DUE UPON RECEIPT OF STATEMENTS. Failure to make payment in full within 30 DAYS of any statement will automatically authorize Company to charge the credit card on file.

In the event that the account remains unpaid for any reason, RELIABLE LIMO may pursue legal action and will hold applicant and/or Company liable for all legal and other related expenses, including but not limited to attorney fees, court filing fees, and any other expenses incurred in the collection process.

The undersigned hereby confirms that cancellations of any reservation must be made within 6 hours/days for a full refund. Cancellation within 5.59 hours is subject to 100% of the total balance due for the particular trip.

Please print your full name below to signify that you agree with the terms and conditions:
Date:
   
Comments: