Contractor Company Details

To be completed by customer :

Commencement Date:

Client Name :

ABN :

Site Name :

Email Address :

Address of Premises :

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Services Required Details :

Date :

Service Required :

Commencement Time :

Conclusion Time :

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SITE BRIEF/SITE INSTRUCTIONS :

AFTER HOUR CONTACTS (please list in order of priority)

RUN NUMBER DAY :

Name :

Phone :

Email :

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Credit Card Authority :

To be completed by the customer...

Customer :

Trading Name :

Cardholder Name :

Card Type :

Master Card

Visa

Discover

Card Number :

CVV Number :

Expiry Date : (Mm/yyyy)

Signature

I, the undersigned, confirm that I authorise Metropolitan Guard Services to use the above credit card to pay for any charges owing in relation to the provision of services of Metropolitan Guard Services to the Customer accommodation including any additional charges arising in accordance with the agreement between the Customer and Metropolitan Guard Services.

Note: (we charge 3 % on all credit card payments)

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Additional Information/Comments :

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By signing below and submitting this form you consent to the collection, use, and disclosure of your personal information for any relevant matter to the service.

By submitting this form, The Applicant represents that all statements made above are true and correct. The Applicant is hereby notified that a consumer report containing credit and/or personal information may be referred to in connection with this rental. The Applicant authorizes the verification of the information contained in this application and information obtained from personal references. This application is not a Rental or Lease Agreement. In the event that this application is not accepted, any deposit submitted by the Applicant shall be returned.

Signature

Date

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