CREDIT APPLICATION Type * Freight Brokerage Other Company Name * Shipping/Receiving Street Address * Zip * State * Select a State/Province Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick New Foundland Nova Scotia Northwest Territory Ontario Price Edward Island Quebec Saskatchewan Yukon City * Select a City Phone * Fax GST Same as Shipping/Receiving Billing Address * Zip * State * Select a State/Province Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick New Foundland Nova Scotia Northwest Territory Ontario Price Edward Island Quebec Saskatchewan Yukon City * Select a City Date of Incorporation / Partnership* Duns 1.Names of Principals Officers * Title * 2.Names of Principals Officers Title Billing Currency * CND USD A/P Contact Name * A/P Phone Number * A/P Email Address * Estimated Monthly Credit Requirement Special Billing Instructions Bank * Address * Branch * Phone * Customs Broker Phone To the best of my knowledge the above statements are true. My signature below A) indicates my permission to obtain credit information from the sources referenced and B) attests financial responsibility and willingness to pay invoices in accordance with terms. Credit Terms are 30 Days Signature * DATE * Position * (Office use only) Collection procedures are governed by items 435 and/or 440 of the rules of HRCF 100 Sales Executive Code Approval DATE Limit Enter the contents of image *
