| Account ID | _____________________________________________________ |
| Company Name | _____________________________________________________ |
| Contact Name | _____________________________________________________ |
| Phone Number | _____________________________________________________ |
| Fax Number | _____________________________________________________ |
| E-Mail Address | _____________________________________________________ |
| Your Card Details: | |
| Card Type | Amex Discover Master Card Visa |
| Expires | _____________________________________________________ |
| Account # | _____________________________________________________ |
| Name on Card | _____________________________________________________ |
| Credit Card Billing Address |
_____________________________________________________ _____________________________________________________ _____________________________________________________ |
| Agreement & consenting authorization: | |
|
I , ____________________________________ , OF ____________________________________ , |
|
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authorize Net Limos (charge name Airport Commuter) to charge my credit card
on a monthly basis, for charges my account acquires based on the lead
quotations I receive from Net Limos’ advertising and referral service. I
understand that this account can be cancelled at anytime, provided that
express written notice is given by sending e-mail to admin@NetLimos.com or
by faxing: +1-650-228-1981. I understand that I am liable for all fees up
until the cancellation date. I have read and understand the NetLimos.com
Terms of Service. Welcome! With your membership, you can enjoy our free lead promotion until June 30th, 2003, avoid our set-up fee of $45, and get all the benefits of membership with no annual fee for all of 2003. Please note that you can cancel your account at any time. By signing below, you indicate that you have read and agree with all Net Limos’ Terms of Service. I accept the above Agreement & consenting authorization.
Name ____________________________ Signature : ____________________________ |
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