AFFILIATE ACCOUNT APPLICATION

Name of business

Year established

Address *

City *

State / Province *

Postal code *

Country *

Years at address

Phone *

Mailing Address (If different than above):

Kindly provide an e-mail address to receive reservation confirmation

Kindly provide an e-mail address to receive reservation trip receipt:

Ownership

Sole

Partnership

Corporation

Credit Card Authorization:

Full Name *

Credit Card Number *

Expiration Date *

Credit Card Billing Address *

I hereby authorize Vitesse Worldwide to use my credit card above for any Ground Transportation service rendered, current or future.

CCV#: (3 or 4-digit code that is found on the front or on the back of your card *

Full name as it appears on the credit card *

Residing at

Upload your signature

Clear

Print Name

Additional Info

Kindly return this form with a copy of the front and back of your credit card.

Terms and Conditions: The Company is responsible for all changes, orders and rides taken on the account. This includes “no show” charges. In order to close the account we must be notified in writing. All check payments must have the account number, invoice number and be paid to the order of Vitesse Worldwide, LLC. If the company changes its name, a new application must be submitted. All invoices are payable upon receipt. Payments received after 30 days of the invoice date will incur a 1.5% per month or 18% per year finance charge. You will be charged a service fee of $25.00 for all bounced or returned checks.