American Liberty & EXERT USA Limo, Inc. - Corporate Account Form

863 Coleman Avenue, San Jose, CA 95110
Tel: (408) 287-8300~ Toll-Free: (800) 900-1027 ~ Fax: (408) 287-8123

Application for Corporate Account Credit Line

Business Name:

Business Address:

City: State: Zip:

Business Telephone: Fax:

Is this business incorporated? Yes No

Number of years in business:

State of incorporation:

Federal Tax ID#:

Brief description of the business:

Will this be a credit card account? Yes No

Credit Card Information: Visa M/C Amex Discover

Credit Card Number:

Exp. Date:

Name on Card:

In the event that this credit application is approved, the applicant hereby agrees to and accepts the following terms and conditions. Full payment shall be due upon receipt of statement, failure to make payment in full within fifteen (15) days of statement closing date will subject applicants account to finance charge, which will be computed on the average daily balance at a monthly rate of 2% (Annual percentage rate of 24%) In the event that the account remains unpaid and legal fees therefore are incurred by American Liberty & EXERT USA Limo, Inc., to obtain payment for services rendered or for information and assistance American Liberty & EXERT USA Limo, Inc., may require from whatever source it deems necessary to obtain payment. The applicant shall be held accountable for all expenses incurred in the collection process. The undersigned on behalf of the applicant authorizes American Liberty & EXERT USA Limo. Inc., to conduct a complete and thorough check of all the information supplied to American Liberty & EXERT USA Limo, Inc. Furthermore, the applicant certifies that the above statements are true, correct, and complete, and have been made by the undersigned for the purpose of inducing American Liberty & EXERT USA Limo, Inc. to extend credit to the applicant knowing that American Liberty & EXERT USA Limo, Inc. will rely thereupon, furthermore, the undersigned is fully aware of American Liberty & EXERT USA Limo's, Inc. cancellation, reservation and billing policies and will have in their possession a written copy of said policies included in the documentation entitled "Company History Structure Service and Policies".

Name:

Title:

Date: