Account Opening Form

CAPTAIN TAXI LTD

ACCOUNT OPENING FORM
ACCOUNT / BUSINESS NAME*
ADDRESS*

STREET ADDRESS

CITYPROVINCE

POSTAL CODE
BILLING PHONE*

AREA CODEPHONE NUMBER
BILLING EMAIL*
PAYMENT MODE*
INVOICE FREQUENCY*
START DATE

DayMonthYear
END DATE

DayMonthYear
People Authorized to use Services
DISPATCH NOTES
PRIMARY CONTACT NAME*

FIRST NAMELAST NAME
CONTACT PHONE*

AREA CODEPHONE NUMBER
CONTACT EMAIL*
Booking procedures:

Book via
Email: dispatch@captain.taxi
Phone: 306-242-0000
Text: 306-242-0000
Online: www.captain.taxi
Should be Empty: