800.399.7411
 
CREDIT APPLICATION Your satisfaction is our primary goal. We are confident that you will be 100% satisfied with the quality of our service.

Company Name

E-Mail

Business Activity

Years in Business

Sole Proprietor - SSN/EIN

Individual - SSN

Partnership - EIN

Corporation - EIN

Owners, Officers or Partners

Name

Title

Home Address 

City

State

Zip

Telephone

 

 

Shipping Info

Shipping Address

Phone

Fax

Contact

Billing Info

Billing Address

Phone

Fax

Contact

Bank Reference

Bank Name

Address

Phone

Account Number

Contact Person

 

 

Trade Reference

Business Name

Address

Phone

Fax

Business Name

Address

Phone

Fax

Business Name

Address

Phone

Fax

Business Name

Address

Phone

Fax

The above hereby applies for credit in accordance with the terms (net 15 days) and conditions of Action-Port Courier Inc. and authorizes release of credit information from the above named references. We certify that all of the information on this is true and correct. We fully understand your credit terms and agree to timely payment in consideration for the extension of credit.

Date

Name & Title