WORLD TRANS Personal Account Contract Agreement Name: _______________________________________________________ Purpose of Account ____________________________________________ Person(s) authorized to transport__________________________________ Contact Person: _____________________________ Phone Number : (____)___________ 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 Card: _________________________________________  Security Code#________ Authorization Section: Where can we transport the client(s) to? __________________________________________ ___________________________________________________________________________ ____________________________________________________________________________ ___________________________________________________________________________ For how long is World Trans 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-ups 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 calls no less than two (2) hours prior to scheduled pickup time to avoid being 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 for the scheduled service call. 3. Waiting Period: Clients will pay an additional surcharge if the driver is delayed more than 15 minutes after the clients scheduled time of pickup. Waiting time is also required when the scheduled trips are out of the normal area of service. 4. Billing: The client's credit card information provided above will be charged the same day as the service is provided, unless the client chooses to pay the driver directly the same day of service. 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 and before 7am will be charged an additional $20. 8. Rates: Wheelchair pick-up rates are $34.75 response to call + $3.25/mile. These are the standard rates as mandated by the City of Los Angeles. Additional surcharges may apply such as waiting time or late pick-up fees. *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 Signature_______________________________________Date: ________ Print Name __________________________________________________