Corporate Account Application

Please print or type the following information except where signature is required.

 
  Company or Business Name
  Contact person(s) for billing only
  Street address
 

Business phone

  Date of Birth
Month     Day Year
  City
  Number of years at this address
  Street
  State
  Zip
     
  Ownership:  
  Corporation
  Check here if incorporated within the past 12 months
 

Partnership

  Name of principal(s)
  Street
  City
  State
  Zip
  Phone
     
  Street
  City
  State
  Zip
  Phone
     
  Personal Guarantor
(Small business/independents)
  Name and title (Please print)
  Date
 

Signature (By signing, I acknowledge financial responsibility for this account, in its entirety.)

 
  Financial Institution Disclosure  
  Name of bank
  City
  State
  Phone
  Extension
 

Bank officer or bank contact person(s)

 

References Please provide the name, address, and phone number of 3 business references
  Name of business
  Address
  City
  State
  Zip
 

Phone

     
  Name of business
  Address
  City
  State
  Zip
 

Phone

   

 

 Name of business
  Address
  City

 

 State
  Zip
 

Phone

     
  Name of business
  Address
  City
  State
  Zip
 

Phone

 

Allow atleast 2 working days to process your application. You must provide a list of all personnel authorized utilize Checkerservices, all personnel must give account number when calling or they will be denied service. Services pertain to passenger transport, package delivery, and courier services.

Current applicable rates (set forth by the city) are as follows:
$2.00 for the first 1/7 of a mile, .25 each additional 1/7 mile thereafter, and $18.00 per hour waiting charge.  Additional charges may apply.  Accounts are billed monthly; unpaid monthly charges accrueinterest at 1.5%. By signing below, you affirm all information is correct, agree to the terms of credit and conditions as stipulated by CheckerCab Company, and accept responsibility for payment of account charges.

  Name and title (Please print.)
  Signature (Required)
 

Date


(yyyy-mm-dd)
  CCC Verification by:
   on :  
 

Approved or Denied :

 
 
Security code captcha
 *  All the fields are mandatory.
Untitled Document
image
 
go
 
Untitled Document