APPLICATION FOR CREDIT
Additional attachments with company information will not be accepted as a credit application.
Note: ALL fields are REQUIRED!
Company Name
Telephone Number
Company Address
City/State/Zip
Federal ID #
Number of Years in Business
Type of Busniess
How Referred
Amount of Credit Requested
Projected Loads (Monthly)
BANKING REFERENCE:
CURRENT LENDING INSTITUTION:
Name of Bank
Representative
Account #
Telephone #
Fax #
Name of Lender
Representative
Account #
Telephone #
Fax #
List at least (3) Three Current (Trucking) Creditors:
Name
Address
Telephone #
Fax #
Name
Address
Telephone #
Fax #
Name
Address
Telephone #
Fax #
Name
Address
Telephone #
Fax #
Name of Person to Contact in the Event of Delayed Payment of Our Invoices:
Name
Title
E-Mail Address
Telephone #
Mailing Address
Name of Supervisor of Above Named Person:
Name
Title
E-Mail Address
Telephone #
Mailing Address
Name of Representative
Title
E-Mail Address
Telephone #
Electronic Signature
Date
PLEASE NOTE: This application SHALL NOT Be Processed Unless ALL above Spaces are COMPLETED. * Additional faxes with company information will not be accepted as a credit application.
Fax Number
U.S. INTERMODAL CORP.
