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Credit Application
Company Information
Legal Company Name
Trade Name or DBA
(Optional)
Officer Name and Title
(Optional)
Email
Address
Location
Federal Tax ID Number
(Optional)
State and Date of Incorporation
(Optional)
BUSINESS INFORMATION
Type of Business
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Years in Business
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Number of Employees
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Annual Revenue
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Bank Institution
(Optional)
ACCOUNTS PAYABLE INFORMATION
Accounts Payable Contact
Email
Phone
Ext.
(Opt.)
Billing Information
Copy From Company
Company Name
Address
Location
Contact
(Optional)
Phone
(Optional)
Ext.
(Opt.)
Credit Information
Requested credit limit per month
Application for following Service(s):
LTL
Dedicated
Fleet Maintenance
Previously established Credit with AAA Cooper Transportation, Midwest Motor Express or DHE Transportation
Invoicing Information
Delivery Method
Frequency
Daily
Weekly
We understand and will comply with regulations requiring payment of all Freight Charges within fifteen (15) days of receipt of statement.
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