New Town Coach
Charge Account Application
NAME
TITLE
COMPANY (If corporate account)
BILLING ADDRESS
CITY STATE ZIP
PHONE FAX
E-MAIL
NO. OF DEPTS. USING THIS ACCOUNT
PAYMENT OPTIONS
1. CREDIT CARD You will receive an itemized monthly statement with the total amount, which will be then charged to your credit card. (all major credit cards welcome!)
NAME ON CREDIT CARD
CREDIT CARD TYPE
CREDIT CARD NO. EXP. DATE
2. MONTHLY BILLING will be mailed to you and is payable on receipt.
Please furnish three trade credit references and allow time for processing.
COMPANY
PHONE
ADDITIONAL INFORMATION
Please provide the following information about what type of service you require:
TYPE OF ACCOUNT
Individual Corporate
If corporate, number of individuals expected to use our service:
5 or fewer 5-10 More than 10
Number of expected trips per week:
Most frequent airport destinations:
Logan Manchester T.F. Green
Other frequent destinations:
Please list any special needs or concerns you may have in using our services (besides timeliness & cleanliness, of course!)
Check here if you would also like to be enrolled in a voucher program
I acknowledge that I am duly authorized to sign and have read and accept all terms & conditions set forth herein by the New Town Coach.
