*PLEASE PRINT AND FILL OUT ALL INFORMATION COMPLETELY AND ACCURATELY AND MAIL OR FAX TO THE ABOVE ADDRESS OR NUMBER. A LIBERTY/YELLOW CAB REPRESENATIVE WILL CONTACT YOU SHORTLEY REGARDING SETUP.

SECTION A- 
CONTACT INFORMATION:

COMPANY OR
BUSINESS NAME:____________________________________

ADMINISTRATION CONTRACT:___________________________________

      POSTION:_________________________

BILLING CONTACT:_________________________________________

POSTAL ADDRESS:____________________________________

STREET ADDRESS:____________________________________

PHONE NUMBER:____________________________

FAX NUMBER:_________________________

TAX ID NUMBER:__________________________

MOBIL NUMBER (OPT):___________________________

E-MAIL ADDRESS IF
           APPLICABLE:_____________________________________

SECTION-B
TYPE OF BUSINESS:

• ___ SOLE TRADER
• ___ PARTNERSHIP
• ___ COMPANY

IMPORTANT POLICY

Please understand that, we, at Liberty/Yellow Cab go to great lengths to protect our clients from account fraud by guarding their accounts as "confidential." It is our strict policy that we do not provide callers with account numbers when placing cab orders. When a caller is unable to provide their account information, they are asked to call back when they can. This is a security measure that was adopted to protect our clients from any potential fraudulent use of their account.

For your personal/company's vital protection, your account number should not be given out to anyone. If for some reason you decide to provide your account number to anyone, you do so in understanding that your personal/company account is responsible for payment without exemption. It is important that anyone having an access to your account information is informed, aware, and abides to the travel parameter/limitations by you or your organization(i.c. no waiting time allowed, travel allowed only to specific locations, etc.) Your personal/company is solely responsible for the payment of services rendered by passengers or employees' "misuse" authorized to travel on your account.

We do appreciate your business and strive to ensure that you receive the best possible service. Please feel free to contact me at anytime for any special needs, requests, questions or concern you may have.

Sincerely,

Mary J. Ventura
Accounts Manager

X_____________________________ (Signature Required)
**Liberty Cab reserves the right toapprove/deny application**