State Line Pilot Car 
& Permit Service, LLC
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Returning costumer?  Your all done. Thank you for your order.

New costumer? Please continue to complete registration so your order can be processed.
Please fill out the client registration form. Also payment must be set up prior to receiving your order. You can fill out a credit card authorization form below. It may be possible to arrange other methods of payment. But we strongly prefer the use of a credit card.

These Forms can also be emailed or faxed to you upon request.
Office (585) 394-9364
Email freddiealbrecht@aol.com

New client registration form

State Line Pilot Car & Permit Service, LLC

4052 Stoddard Rd

Canandaigua, NY 14424

Office: 585-394-9364      Cell: 585-766-2318     Fax: 516-208-2081

E-mail: Freddiealbrecht@aol.com

company name: *
Contact person: *
Billing Address: *
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FEIN #: *
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Credit Card Authorization Information

Name as it appears on card: *
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 Card Number: *  
 Expiration Date: *  
 Three Digit CVV/CVC code: *  
 Todays Date: *  
 You agree that all the above information is true and give State line Pilot car
permission to apply charges
to above mentioned credit card
Agree