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Clean Air Limo LLC

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									                           Clean Air Limo LLC
  512-262-1212  www.cleanairlimo.com  P.O. Box 92451  Austin, TX 78709-
                                   2451

                                 Account Application

Applicant Information:

Date: ___________ Applicant’s Name: ________________________________

Address: ________________________________________________________

Phone: ______________________ Alternative Phone: ____________________

Email: ___________________________________________________________

Account Type (circle one):         Individual          Corporate

Fill out the following information if applying for a corporate account:

Contact Name(s): __________________________________________________

Description of Business: ____________________________________________

Credit Card Information:

Credit Card Type (circle one):     MasterCard          Visa        Discover

Credit Card Number: ______________________ Expiration Date: ___________

Security Code (3 digits on back of card): ____________

PLEASE ENSURE THAT YOU AGREE TO ALL OF THE FOLLOWING BEFORE
CONTINUING:

1. Clean Air Limo LLC is authorized to verify any and all information listed on this
application.
2. Applicant agrees to pay Clean Air Limo LLC for all transportation services provided to
Applicant by Clean Air Limo LLC. Such transportation shall be provided to applicants,
their affiliates, partners, representatives, employees, guests, agents, customers, clients
and others who identify themselves as authorized users.
3. Applicant agrees to pay Clean Air Limo LLC for all charges billed under customer's
account including waiting time and "no show" charges.
4. Payments for services rendered will be charged to the Applicant’s credit card on
completion of services unless the Applicant and Clean Air Limo LLC agree to an
alternative billing plan.
5. The signatory warrants that he/she is authorized to enter into this agreement on
behalf of the applicant and that the firm listed will assume all financial obligations with
regard to Clean Air Limo LLC charges incurred on the account.
6. This agreement is made under and shall be governed by the laws of the State of
Texas.
7. Clean Air Limo LLC shall not be held responsible for any loss or damage arising out of
delays occasioned directly or indirectly by Acts of God, or any other emergency or
condition beyond the control of Clean Air Limo LLC.
8. This Agreement is not assignable or transferable by applicant without consent of
Clean Air Limo LLC to such assignment or transfer. This Agreement cannot be changed
or terminated, and no provision thereof can be waived, except by a statement signed by
Clean Air Limo LLC. No waiver by either party of any default or breach of any provision
hereof shall be deemed a waiver of any subsequent default or breach.
9. Applicant agrees to be bound by the terms and conditions of this application.
Applicant acknowledges that this application will become a binding contract only after
the application has been submitted and Clean Air Limo LLC has indicated its acceptance
by notice to Applicant. No modifications or additions shall be binding upon Clean Air
Limo LLC and/or its affiliates unless agreed to in writing.

CLEAN AIR LIMO LLC MAKES NO WARRANTY OF ANY KIND, EXPRESSED OR
IMPLIED, AS TO THE SERVICE COVERED HEREBY, EXCEPT AS PROVIDED IN
THE TERMS AND CONDITIONS OF THIS AGREEMENT.


______________________________                               ____________________
Signature of Authorized Individual                           Date

______________________________
Printed Name

______________________________
Title (if opening corporate account)

Please return this form with the following to complete your client file:
   1. A legible copy of the front and back of the credit card listed on this
      application.
   2. A legible copy of the front of the cardholder’s driver’s license.
These copies are required to verify credit card authorization. This information will go into a
permanent file so that all future reservations can be drawn from this information. Our office policy
requires this information to protect you from credit card fraud. Thank you for your cooperation.

Applications and supporting documents should be sent by mail, email, or fax to:

Clean Air Limo LLC                      Fax: 512-268-1220
P.O. Box 92451                          Email: customerservice@cleanairlimo.com
Austin, TX 78709-2451

								
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