Account Application for Organisation

GTA Accessible Transportation Inc

Direct Billing Account Application for Organization

Today's Date *

Name of the person setting up this account *

Job Title *

Phone Number of a Person's setting up this account *

Extension

Email Address of a Person setting up this account *

Company Name/Registered Business Name *

Established Since *

Business Type *

Business Number

Legal Status

Business Address *

Apt, suite, etc.

Country

City

State

Zip code

Business Fax Number

Business Email Address

Credit References/Suppliers

Please List few Names Addresses Telephone Numbers and Account Numbers

Bank Trust / Company Name and Branch Address

Account Numbers

Select Invoice Option *

How do Like to receive Your Invoice

Does Client Requires Wheelchair Accessible Vehicle

YES

Passenger"s Full Name

Passenger's Home Phone

Passenger's Mobile Phone

Passenger's Email

Passenger's Address *

Country

City

Restrictions

Please let us know if there are any restrictions on travelling locations

Frequent Travelling Addresses

Special Instructions

Signature *

Signature is required.