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CREDIT APPLICATION
Company Name

Amount of credit requested

Contact Name

Address
City
State/Prov
Zip/Postal Code
Country
 
BILLING (if different from above)

Billing Address

City

State/Prov

Zip/Postal Code

Country
 

COMPANY

# of Employees

Toll Free

Telephone

Fax

Email

 

Type of Business

Operating since
Funds CDN USD
Nature of Business
How often do you ship?
Would you be interested in placing your order on the web? Yes No
What are your average yearly freight costs?
What are your primary shipping lanes? Origin :
Destination :
Do you utilize outside warehousing? Yes No
Does your company: Utilize outside carriers
Private fleet

President or Owner

Controller/General Manager

Accounts Payable Contact

Tel/Ext.#’s
Canadian Customs Broker

Telephone

Fax
U.S. Customs Broker

Telephone

Fax
BANKING INFORMATION

Bank

Line of Credit

Address

City

State/Prov

Zip/Postal Code

Country
 

Account #

Contact

Telephone

Fax
CREDIT INFORMATION References (please include 1 transportation and 2 trade references)
Reference 1

Telephone

Fax
Reference 2

Telephone

Fax
Reference 3

Telephone

Fax
I hereby apply for credit with EVEREST TRANSPORTATION INC. I understand that the terms of payment on this account are “NET 7 DAYS” and I agree to pay the account on that basis. I warrant and confirm that the information given herein is true and accurate, and I understand that it is being used to determine my credit responsibility. You are authorized to obtain any information you may require relative to this application from any source to which you may apply and each such source as such is hereby authorized to provide you with such information. I also accept liability limited to $2.00/lb. unless agreed to in writing by Everest Transportation.
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Date  
 
 
 
© 2005 Everest Transportation Inc.
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