BLS ACCOUNT APPLICATION



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( CORPORATE Account Application ( INDIVDUAL

Applicant Name: ________________________________________________________________________________________________________

Company Name: _________________________________________________________ FED I.D. # / SS#________________________________

(If applicable)

Company Address:

Address: _____________________________________________ City: __________________ State: __________ Zip: ___________

Billing

Address: _____________________________________________ City: __________________ State: __________ Zip: ___________

Telephone # ___________________________________________ Fax # _______________________________________________

Home Address:

Address: _____________________________________________ City: __________________ State: __________ Zip: ___________

Telephone # ___________________________________________ Fax # _______________________________________________

E-mail Address: __________________________________________________________________________________________________________

Credit Card Information:

( Amex ( Master Card ( Visa ( Discover ( Diners Club

Card Holder Name: __________________________________________________________________________________________

Address #: ___________________________________________ City: __________________ State: __________ Zip: ___________

Telephone # ___________________________________________ Fax # _______________________________________________

Credit Card # ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Exp.: ( (/( (

An attached copy of the Front and Back of the Credit Card must accompany this Application.

Bank Information:

Bank name: _____________________________________Account #: _______________________ Phone #: _________________

|Business References: |

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|Name/Address: ______________________________________________________________ Phone #: ___________________ |

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|Name/Address: ______________________________________________________________ Phone #: ___________________ |

The undersigned herby acknowledges and agrees that BLS is relying upon the within application in extending luxury ground transportation service to this applicant. Additionally to avoid the inconvenience to each passenger of signing charge records at the conclusion of each transfer, the undersigned herby authorizes the Credit Card Company to permit this application to serve as my authorization to charge the above credit card in lieu of signing individual charge records or travel and entertainment sales slips for each rendered service.

Print Name: _______________________________________ Signature: ______________________________________________

Please Fax completed application to: ______________________________ Attention: _______________________

BLS Office use only

Account #: _______________________ Date Opened: _______________________ Rate Group: _______________________

Opened by: _______________________ Approval #: _______________________

BLS Limousine Service, Inc 18-20 Steinway Street, Astoria, NY, 11105 Worldwide Reservations (800) 843 5752 Fax (718) 267-5452

For general terms and conditions go to:

terms

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