| The following information will be needed for our Accounts Receivable Department |
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| Firm Name: ________________________________________________ Tax ID # _____________ |
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| Owner's Name: __________________________________________________________________ |
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| Address: _______________________________________________________________________ |
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| City: _______________________________ State: _______________ Zip Code: ______________ |
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| Telephone#: _____________________ Fax#: ___________________Email: ___________________ |
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| Where would you like vouchers to be sent?(If the same as above please check here): __________ |
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| Mail To: ________________________________ Attention: _______________________________ |
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| Address: _______________________________________________________________________ |
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| City: _______________________________ State: ________________ Zip Code: ______________ |
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| Telephone#: _____________________ Fax#: __________________ Email: ___________________ |
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| Where would you like your invoice to be Emailed |
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| Email Address ___________________________________________________________________ |
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| Please, provide us with you contact person in the Accounts Payable Department. |
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| Contact Name: ___________________________________________________________________ |
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Office Use Only
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| Account # _____________ |
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Bank References
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| Bank Name: __________________________Date Account Open:___________________________ |
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| Address: _______________________________________________________________________ |
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| City: _______________________________ State: ________________ Zip Code: ______________ |
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| Account# ___________________________ Telephone#: __________________________________ |
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IMPORTANT!
PLEASE READ BEFORE SIGNING
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I/We, acknowledge that the issuance of Metro Cab Association, Inc. Vouchers may be revoked at any time without notice, at the discretion of Metro Cab Association, Inc. Upon revocation, all voucher books and materials will be returned to Metro Cab Association, Inc. forthwith. I also acknowledge that I am responsible for any vouchers issued to my account.
As of September, 2002, a two percent (2%) processing fee is added to all voucher accounts.
By signing below I/We acknowledge that I/We understand the terms and conditions of Metro Cab billing. I/We also certify that the within information is true and correct.
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| Owner(s) Signature: ____________________Print Name: _____________________________ |
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84 Braintree Street, Allston, Ma 02134 Office: 617.787.5438 Fax: 617.787.2346
Email: support@metro-cab.com Web Site: www.metro-cab.com
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