| 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 Airport Courier Service 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 |
|
|
|
|
