Corporate Account Form Copy and Fax to 1-718-383-9563 or fill out form on secured server. Signature is required.

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Company *

Name on Card *

Credit Card Type *

Credit Card Number *

Code: *

Expiration Date (mm/yy) *

Signature *

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Terms And Conditions:

All accounts will be billed on a monthly basis. All charges are thirty (30) days net after receipt of statement.
Client mentioned above personally guarantees payment of any all charges, including but not limited to all collection and attorney fees (sin. $250.00) in case of delinquency. Accounts carried over to the next statement are subject to a $5.00 service charge in addition to the assessment of a 1.5% monthly finance charge.
Inordinate delay in payment will result in the suspension and/or cancellation of charge priileges in addition to the assessment of monthly finance and service charges.

Late Cancellation Fee - Any pick-up that is cancelled less than four (4) hours before pick-up time will be considered a late cancellation and will be subject to charges.
In addition to filling out this form, Corporation must submit a request for credit voucher charges on company letterhead.

Authorization is given to Mobile #1 Car Service , Inc. to obtain any information regarding this credit application.