Credit Application

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CUSTOMER GENERAL INFORMATION

How did you hear about us *

Contact Email Address: *

Primary Contact First and Last Name: *

CUSTOMER BILLING INFORMATION

Legal Business/Individual Name *

Telephone *

E-mail *

City *

ZIP Code *

Accounts Payable Phone # *

Number of Years in Business *

Tax Exemption *

MC # / FF # / DOT # *

MC # / FF # / DOT #

Federal Tax ID/SSN # *

Fax

Registered Company Address *

State *

Accounts Payable Contact Name *

Accounts Payable E-mail *

Amount of Credit Requested *

Do you have a Broker or Freight Forwarder bond? *

Business Commenced Type

Sole Proprietorship

Partnership

Corporation

Limited Liability Company

Other

BUSINESS AND CREDIT INFORMATION

Primary Business Address *

State *

How long at current address? *

Fax

Type of industry *

Bank Name *

Phone *

State

Bank Contact

City *

ZIP Code *

Telephone *

E-mail *

Estimated Annual Sales *

Bank Address

City

ZIP Code

BUSINESS/TRADE REFERENCES

Company Name

City

ZIP Code

Fax

Address

State

Phone

E-mail

Company Name

City

ZIP Code

Fax

Address:

State

Phone

E-mail

Company Name

City

ZIP Code

Fax

Address:

State

Phone

E-mail

AGREEMENT

TERMS NET 15 DAYS
By submitting this application, you authorize Fast Exact to make inquiries into the banking and business/trade references that you have supplied.

SIGNATURE

Signature *

Name and Title *

Date: 04/19/2024

Credit Application

CUSTOMER GENERAL INFORMATION

CUSTOMER BILLING INFORMATION

BUSINESS AND CREDIT INFORMATION

BUSINESS/TRADE REFERENCES

AGREEMENT

SIGNATURE

We have over thirty years experience in the industry.