Credit Application

Company Details:
Name:*
Address:*
Street Address City State ZIP Code
Telephone:*
Fax:
Email:*
Number of Years in Business:
Accounting Department Details
Accounts Payable Contact(s):
Phone:
Email Where Invoices Get Emailed:
Banking References
Bank Name:
Branch:
Address:
Phone:
Fax:
Account No. :
Contact:
Title:
TRUCKING REFERENCES. MUST BE 3 TRUCKING COMPANIES. DO NOT LIST THE FOLLOWING TRUCKING COMPANIES FOR THEY WILL NOT GIVE REFERENCES; TOWNE AIR FREIGHT, LAND AIR OR FORWARD AIR.
Business Name:
Address:
Phone:
Fax:
Contact:
Title:
Business Name:
Address:
Phone:
Fax:
Contact:
Title:
Business Name:
Address:
Phone:
Fax:
Contact:
Title:
Terms & Conditions
The undersigned agrees to pay for all services according to terms of "Net 30 Days." No terms or conditions of terms different from the terms of "Net 30 Days" will become part of any sales agreement or other documentation, unless otherwise specified and approved by the Creditor. Payments may be applied against open charges at the discretion of the Creditor. The undersigned agrees that the Creditor may utilize outside credit reporting services to obtain information on the undersigned.

The person signing this application certifies that he/she is authorized to do so and that all of the information contained in this application and any attachments is true and correct to the best of their information, knowlegde and belief. We fully understand your credit terms and agree to the proper payment in consideration of extended credit.
Date:*
Date Format: MM slash DD slash YYYY
Signature:*
Title:
Printed Name:
Name
This field is for validation purposes and should be left unchanged.

Company Details:

Accounting Department Details

Banking References

TRUCKING REFERENCES. MUST BE 3 TRUCKING COMPANIES. DO NOT LIST THE FOLLOWING TRUCKING COMPANIES FOR THEY WILL NOT GIVE REFERENCES; TOWNE AIR FREIGHT, LAND AIR OR FORWARD AIR.

Terms & Conditions