Name of Company:

Street Address:

City: State: Zip:

Tel#:Fax#:

Federal Tax I.D.#Years in Business:

Corporate Officers (please type or Print) Chairman/CEO:

CFO/Controller

Exec./Sr. VP:

Secretary/Treasurer:

 

Major Credit Card (check one and please type or print)

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Account Number: Exp. Date:

Authorized Person on Account:

DISCLAIMER:  GLENDALE CAR SERVICE  FORWARDS ALL BILLING ON A WEEKLY BASIS TO CLIENTS PROVIDED WITH A "DIRECT BILLING" ACCOUNT. PAYMENT IS DUE WITHIN A NET-15 CALENDAR DAYS UPON RECEIPT. THE ABOVE CREDIT CARD SHALL BE CHARGED UPON CLIENT DELINQUENCY TO COMPLY WITH THIS PROVISION IN THE EVENT "DIRECT BILLING" PAYMENT(S) HAS NOT BEEN RECEIVED WITHIN THIRTY DAYS FOLLOWING THE DATE OF SERVICE.
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