COMPANY INFORMATION

 Company:

 Contact:

 Type of Business:

 Address:

 Floor/Suite:

 City:

 State:

 Zip:

 Phone:

 Fax:

 Cell Phone:

 Email:

 # of Employees:

Approximate dollar amount of radio car service monthly

BANK INFORMATION

 Bank Name:

 Account #:

TRADE REFERENCES

 Reference # 1

 Company:

 Address:

 Contact

 Phone:

 Reference # 2

 Company:

 Address:

 Contact:

 Phone:

In addition to filling out this form, the firm or corporation must submit a letter on its letterhead applying for credit voucher charger. Please include list of all authorized personnel.

PLEASE SELECT THE GRATUITY

 Add 20%

 Add 15%

 Add 10%

This applicant firm assures all financial obligation with regard to charges incurred by their personnel.This will authorize Classic Executive Limousine, Inc. to verify the above information.Classic Executive Limousine, Inc. reserves the right to refuse services to firms who are in arrears.TERMS: NET 10 DAYS

 I Authorized CEL to Verify the above information