WORLD TRANS Medical and Personal Transportation Corporate Account Contract Agreement Name: _________________________________________Purpose of Account (CIRCLE)       Personal        or    Business Company Name: ______________________________________ Contact Person: ______________________ Billing Address: ___________________________________________________________________________ City/Sate______________________________________________________________Zip ________________ Phone: ___________________________________Fax: ______________________________ E-mail: _____________________________________________________________________ Credit Card Information: (to secure account) Type (Circle):   MC   Visa   Amex   Discover Credit Card Number: __________________________________________________________ Exp. Date: ________________                  Name on the card ______________________________________________________________ Authorization Section Where can we transport the clients to? __________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ For how long are we authorized to provide service? ______________________________ Terms and Conditions of Service: in an effort to provide our clients with excellent call response, WORLD TRANS Requests our clients to observe the following terms and conditions. 1. Service Calls/ Appointments: Service calls/appointments shall be made no less than two (2) hours proceeding the intended Pickup time. WORLD TRANS shall not guarantee prompt pick-up for calls made less than two (2) hours prior to the intended pick-up time. Such calls will be honored based upon availability of vehicles and upon assessing the distance between available vehicles and pick-up point. 2. Cancellation of Service Calls: Clients must cancel service call no less than two (2) hours prior to scheduled pickup time to not be charged for the service. After that period, if the driver is en-route, or has arrived at the pick-up location, the client's account will be billed $34.75 cancellation fee. 3. Waiting Period: Clients will pay an additional surcharge if the driver is delayed more than 20 minutes after the clients scheduled time of pickup. 4. Billing: The client's credit card information provided above will be charged the same day as the service is provided. World Trans does not offer other billing options. 5. Payment: A credit card number is required to secure the account. The same credit card will be charged for services rendered. 6. Indemnity: WORLD TRANS shall maintain a comprehensive insurance policy on all its vehicles. The liability of WORLD TRANS for damage to client(s) body or property shall not exceed the amount Recoverable from such insurance. 7. Late Pick-Up Fees: Pick-ups after 7pm will be charged an additional $20. *This agreement shall be binding upon the party’s successors and assigned personal representatives. This agreement shall be Enforced under the laws of the State of California Client Signature_____________________________________________________ Date:_________________ Print Name _________________________________________________________________________ Title_______________________________________________________________________________