PAYG Application – Tara Courier Services Ltd.

Client Application for Pay-as-you-go Account

Primary Contact

First Last

Company Name

Company Address

Street Address Address Line 2 City Parish Postal Code

Telephone Number

Email Address

Please provide us with the name(s) of the additional person(s) who will be authorized to place order on this account.

Name

First Last

Phone (O)

Phone (M)

Email

Name

First Last

Phone (O)

Phone (M)

Email

I/We understand that our organization is responsible for all transactions booked by our designated representatives and any relevant charges incurred will be subject to the terms and conditions of the Charge Customer Agreement.

Name of Authorized Representative

First Last

Date