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New Account Form
New Account Form
Credit applications are required for all customers not in the CTII system.
Billing Address
Company Name:
Attention:
Address:
Is residential?:
Yes
No
City:
State/Zip Code:
- - -
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
CAN
MEX
USA
Phone:
(
)
-
Email:
Office/Shipping Address
Company Name:
Attention:
Address:
Is residential?:
Yes
No
City:
State/Zip Code
- - -
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
CAN
MEX
USA
Phone:
(
)
-
Email:
Same As Billing Address
General Information
Federal Tax ID #:
Company Composition:
Corporation State:
Individual
Partnership
Corporation
LLC
- - -
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
CAN
MEX
USA
Dun & Bradstreet
(D&B) Number:
At present location
since date :
Are premises
leased?
Amount of credit
desired:
(mm/dd/yyyy)
Yes
No
Contact Information
Principal Contact Name:
Title:
Email:
Phone Number:
(
)
-
Ext.:
Are you an internet shipper via Craigslist or Ebay?
Yes
No
Bank Information
Bank Name:
Account #:
Bank Address:
Account Type:
City:
Bank Contact Officer:
State/Zip Code:
- - -
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
CAN
MEX
USA
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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©2010 Central Transport. All rights reserved.
5/19/2013 - 5:51 PM
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5/19/2013 - 5:51 PM
5/19/2013 - 5:51 PM
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