Client Agreement Form for AVS Hamptons Premier Housekeeping

Please double check your information before submitting this Client Agreement Form.

A contract will be drafted based on your information.

CONTACT INFORMATION
Full Name*
Email*
Home Phone Number*
Business Telephone Number*
Mobile Number*
ADDRESS INFORMATION
Local Address*
Alternate Address
House Watcher Name & Phone Number
Other Contacts and Information
BILLING INFORMATION
I authorize A VOTRE SERVICE to keep my signature on file and to charge my credit card account, on an ongoing basis, for amounts I owe.
It is important to record the cardholder name exactly as it appears on your credit card and to provide the billing address that appears on your monthly statement.
We will contact you by phone for the full credit card details.
Cardholder Name*
Credit Card Type
Last 4 digits of Credit Card*
CC Expiration Month*
CC Expiration Year*
Security Code*
Company Name
Email Address for Invoices*
2nd Email Address for Invoices (Optional)
Address Line 1*
Address Line 2
City*
State*
Zip*
Remember! Please double check your information before submitting this form.
I Authorize A Votre Service! to charge my credit card for services rendered*
- By checking below, I acknowledge that I am the card holder and agree to have A Votre Service! charge the credit card I provided for services rendered. I also agree that it is my responsibility to contact A Votre Service! if there are any changes to my credit card account information.