New House Account | Miles Tech Auto

Company Name *

Email address *

Phone Number *

Street Address 1 *

Street Address 2

City *

State *

Zip/Postal Code *

Billing Zip Code *

Disclaimer *

I hereby authorize Miles Tech Auto LLC to charge the balance due on due date. Payment will be processed upon service completion to avoid late fee .

Late Fee *

Payment is considered late after 2 days of Service. Any balance will be charged to the card on file. In addition, a late fee will be assessed in the amount equal to 1% per late day

Authorization *

Being the authorized cardholder or the Corporate Officer, by signing above I understand and agree to the terms set forth in this agreement, agree to pay, and specifically authorize to charge my credit card for the services provided. I further agree that in the event my credit card becomes invalid, I will provide a new valid credit card upon request, to be charged for the payment of any outstanding balances owed

Storage Fee *

I understand the storage and parking fees policy of Miles Tech Auto. Storage fee starts after ONE day of service completion and hereby I authorize the charges of $35/day for any vehicle stay in the lot after service

Sign Your Name *

Date *

Front of the Card *

Back of the Card *

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