APPLICATION FOR DIRECT BILL ACCO

APPLICATION FOR DIRECT BILL ACCOUNT

Print out this form and fax to Fax: (818) 788-5468

Firm Name:__________________________________________________________________

Address:____________________________________________________________________

City:_________________________________ State:______________ Zip:________________

Business Telephone Number:_____________________ Contact:_______________________

Fax#____________________ E-mail___________________ Website:___________________

Nature of Business:_______________________________ Year Established:_____________

Federal Tax I.D. Number:___________________________TCP#_______________________

Corporation________ Partnership________ Sole Prprietorship____________ Other:_______

Principals:

1) Name:_________________________ Title:______________ Phone:__________________

2) Name_________________________ Title:_______________ Phone:__________________

3) Name_________________________ Title________________ Phone:_________________

Bank References:

Bank Name:________________________ Account Number:__________________________

Bank Address:_______________________________________________________________

City:_______________________ State____________________ ZIP Code:_______________

Telephone Number:____________________ Contact Person:__________________________

Trade References:

1) Name:____________________________ Telephone Number:_______________________

Address:__________________________________________ Contact:_________________

2) Name:____________________________ Telephone Number:_______________________

Address:_________________________________________ Contact:_________________

3) Name:____________________________ Telephone Number:_______________________

Address:_________________________________________ Contact:_________________

Major Credit Card:

Credit card will be used only if a charge is delinquent more than 30 days(Thirty)

days.

Credit Card Number: __________________________________________________________

Cardholder’s Name:_______________________________ Expiration Date:______________

Card Identification Number (the last 3 or 4 digits of the number printed on the back of the card) __________

Credit Card Billing Address:_____________________________________________________

AUTHORIZATION:

I certify that the fact contained in this application are true and complete to the best of my knowledge.

I further agree to submit payments to Hardrock International Limousines on a regular scheduled bases as required by

the governing laws of the Public Utilities Commission. In the event of a delinquency on my account

I authorize Hardrock International Limousines to charge my credit card account listed above.

Terms & Conditions

Rates and Cancellation / No-Show Policy

CANCELATION POLICY: In the continental USA Hardrock International Limousines requires a minimum

Three (3) hours notice prior to the scheduled pickup time (based on the local

time zone of the pickup location) for Airport Sedan service and 24 hour notice for all

other services to avoid late cancellation or no-show charges. Cancellation number should

always be given and noted. It is the client’s responsibility to ask for the cancellation numbers.

NO SHOW CHARGE: If you not able to locate the chauffeur, please call our 24-hour

Customer Service at 877-427-1777 immediately. One of our customer service representatives

will be an able to locate your chauffeur right away. No Show charge will be applied if a passenger fails to call

Hardrock International Limousines before leaving the scheduled pickup location.

A No Show charge will also be applied if the client fails to inform of the cancellation.

CANCELLATION FEE: Late cancellations and No-Show will be charged at a full trip charge.

AIRPORT TRANSFER RATES: The Airport Transfer rates are based on pickup and

drop-off without any delay or waiting time for Domestic flights. Your reserved vehicle is

dispatched according to the flight estimated arrival time provided by the airline automated

system. All rates included 30 minutes airport grace waiting period.

Hardrock International Limousines is not responsible for delays caused by: Delay or loss of

luggage, inaccurate ETA or wrong gate/terminal information, or any unforeseen circumstance. All prices quoted by

Hardrock International Limousines are for the specific services requested. Any deviation from the requested service by

any passenger will result in appropriate additional charges.Hardrock International Limousines reserves the rights

to assess a minimum fee of $150.00 for any necessary cleaning and/or damage to the vehicle beyond normal wear and tear.

Hardrock International Limousines is not liable for delays/service interruptions or damages caused by

acts of God, strikes, riots, authorities of law, public enemies, hazards or dangers caused by a state of quarantine, perils of navigation,

inclement weather, hazardous road conditions, accident or breakdowns or any other condition beyond its control.

The undersigned acknowledges and agrees that all rates quoted for services provided by

Hardrock International Limousines are estimates only. Final charges assessed upon service

completion will be based on the actual service provided. The undersigned acknowledges and agrees that

Hardrock International Limousines is not responsible for personal property left in the vehicles.

I confirms that I have read this document and agree to the terms and conditions contained therein.

Authorized Signature on Account:__________________________Date:_________________

Print Name:___________________________________________ Title:__________________

IT IS NECESSARY TO ACCOMPANY A CLEAR AND LEGIBLE PHOTOCOPY

OF THE FRONT AND BACK OF THE CREDIT CARD and PICTURE I.D.

Please print out this form and fax to: (818) 788-5468 - 24/7/365

FOR OFFICE USE ONLY

APPROVED BY:_______________________________________ DATE:________________