Billing Authorization Form

By signing this document, I authorize Americ Transit Services to bill the facility/organization for all noted charges for transportation services that have been approved by the signature of the facility/organization’s primary contacts listed below.

Invoices are payable directly to the transportation company and will include a copy of the Transportation Request Form for your records.Americ Transit Services has the authorization to contact the facility/organization on behalf of the transportation company to inquire about the status of the account. The billing is set up to process within 3 days of the completion of the trip. Contact Americ Transit Services within 5 business days of receipt of the invoice for clarification or adjustment.for all noted charges for transportation services that have been approved by the signature of the facility/organization’s primary contacts listed below.

Payment is due 30 days from the date of the invoice. Past due amounts will bear interest from due date at the lesser of 18% per annum of the highest rate permitted by applicable law. In the event of collection proceedings, the facility/organization completing this application, shall pay all collection and other costs incurred by Americ Transit Services and/or the transportation company. This includes, but is not limited to reasonable attorney’s fees, whether litigation is commenced.

This authorization is valid until Americ Transit Services receives written notice of Cancellation. This agreement comprises the entire agreement of the parties relating to the subject matter set forth herein and no provisions of this agreement can be waived except in writing.

(Services will not be provided when this credit amount has been reached or exceeded)

Please provide a list of your employees (include yourself if applicable) that are authorized to request billing for transportation services. Print name and include employee signature:

This authorization is valid until Americ Transit Services receives written notice of Cancellation. This agreement comprises the entire agreement of the parties relating to the subject matter set forth herein and no provisions of this agreement can be waived except in writing.