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Credit Application
I
nterstate
C
ourier
E
xpress
Company Name:
Billing Address:
Physical Address:
*Email Address:
*Phone Number:
Fax Number:
Credit amount Requested:
Person Requesting Credit: Name
Title
Type of Business
Years in Operation
Parent Company
Division of
Subsidiary of:
Corporation
Sole Proprietorship
Partnership
DUNS#
Principals/Officers of the Firm : (Name, Title, Address, SS#)
Bank Reference: (Name, Address, Account #, Phone) Checking:
Saving:
Loan Amount:
Trade/Supply Credit References: (Name, Address, Account #, Phone)
We hereby authorize the above listed bank and Trade References to release information to Interstate Courier Express Inc. for use in evaluation of this freight account request.
Requesting Officer:
Signature:
Title:
Date:
