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New Account Form

Credit applications are required for all customers not in the CTII system.

Billing Address
Company Name:  
Attention:  
Address:  
Is residential?:
City:  
State/Zip Code:      
Phone: ()  -  
Email:   
Office/Shipping Address   
Company Name:  
Attention:  
Address:  
Is residential?:
City:  
State/Zip Code      
Phone: ()  -  
Email:   
General Information
Federal Tax ID #:     Company Composition: Corporation State:
 
Dun & Bradstreet
(D&B) Number:		 At present location
since date :		 Are premises
leased?		 Amount of credit
desired:
      (mm/dd/yyyy)
  
Contact Information
Principal Contact Name: Title: Email:
      
Phone Number:
( )   -    Ext.:
Are you an internet shipper via Craigslist or Ebay?
Bank Information
Bank Name:   Account #:  
Bank Address:   Account Type:  
City:   Bank Contact Officer:  
State/Zip Code:       Phone #:
( )   -  
Branch Name:      
Terms & Conditions
1. All invoices are to be paid 15 days from the date of the invoice.
2. Claims arising from invoices must be made within seven working days.
By submitting this application, you authorize Central Transport, to make inquiries into the banking and business/trade references that you have supplied.
I agree to the terms as stated above.

 



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5/19/2013 - 5:51 PM
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5/19/2013 - 5:51 PM
5/19/2013 - 5:51 PM