Credit Application

Company Name

Physical Address

Billing Address

Maximum Load Value

Do you accept Invoices Via Email? (copies of bills of lading can be attached)

Do You Have LTL Freight?

Company Classification

Year Business Started

Company Type

Estimated full truckloads per week

Accounts Payable

Accounts Payable Contact

Will we invoice a third party payment processor?
YesNo

Will we invoice other locations?
YesNo

Billing Information

To process payment, may we exclude bills of lading from your invoice?

Can we contact you to discuss Electronic Data Interchange (EDI) transactions?

Do you require pallet exchange?

Do you reimburse for unloading charges?

Do you have the ability to pay via ACH?

To process payment, do you require load tenders?

Do you have any additional Billing requirements (We will reach out to your billing contact)?

Bank Reference (Required For Maximum Credit)

Bank Representative

Credit References (Required for Maximum Credit)

Contact Name

General Terms And Conditions

I Accept The Terms And Conditions Contained In this Agreement

By selecting "Accept" above and submit below, I am signing this Agreement electronically. I agree my electronic signature is the legal equivalent of my manual signature on this Agreement. By selecting "Accept" I, and the company/entity I have authority to bind, consent to be legally bound by this Agreement's terms and conditions.

How did you first hear about us?