<%@ Page Language="VB" ContentType="text/html" ResponseEncoding="iso-8859-1" %> Corporate Billing Application
GOURMET SHUTTLE, INC.
CORPORATE BILLING CREDIT APPLICATION AND AGREEMENT
  Company Information:
  Name of Company:      *  
  Phone: *  
Email:
  Address: *             City: *             State:         Zip: *
Type of Business:
How Long in Business?
Proprietorship or Partnership or Corporation?
Credit Limit Requested
*  
*  
*  
  Officers/Owners Information:
  Name:        Title:   Name:           Title:
  Address:   Address:
Home Phone
Soc. Security #
Driver Lic #
Home Phone
Soc. Security #
Driver Lic #
  Delivery Information:
  Names of people authorized to
  receive food and sign the receipt:		   1   2   3
  Billing Information: Where to mail the bill & to whose attention?
  Name:      
  Phone:  
  Fax :  
  Address:  
 City
 State
Zip
  Trade References:
 Name
 Contact
 Phone
Terms
Past Due
* 
  
*
*
Address
City
State
Zip
How Long Doing Bus.
High Credit
*
 *
 
 Name
 Contact
 Phone
Terms
Past Due
 
Address
City
State
Zip
How Long Doing Bus.
High Credit
  Terms and Conditions:
The undersigned hereby agrees to pay all bills when due, to pay a finance charge of 1½% per month on any balance of any sums not paid when due, and to pay all collection expenses, legal costs, and attorney fees which may be incurred in the collection of any sums due under this contract.

The undersigned, by this Application and Agreement, does continually personally guarantee payment for all goods and services delivered by Gourmet Shuttle, Inc. The undersigned personally assumes joint and several responsibility wi th the applicant company.

The undersigned instructs Gourmet Shuttle to add 15% Gratuity for the delivery driver.

THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF OUR KNOWLEDGE. IT IS OUR DESIRE TO OPEN AN ACCOUNT WITH GOURMET SHUTTLE, INC. AND AGREE TO THE TERMS ABOVE.

By submitting the information above, I agree to the terms above and hereby grant permission to Gourmet Shuttle, Inc. to verify our bank and trade references.
 
* Required Fields