Delivery Scheduling Form

CREDIT APPLICATION FORM

ZIPSPEED COURIER SERVICES

Legal Business Name

Trade Name-DBA

Phone #

FAX #

Billing Address

City

State

Zip Code

Shipping Address

City

State

Zip Code

Business Is a: Corporation LLC Partnership Proprietorship

Year Started

State of Inc.

Federal I.D.#

Web Site Address

Dun & Bradstreet #

Are You a: Subsidiary Division (if yes, check which)

Parent Company Name

Address

City

State

Zip

Do you require an order# before we accept a delivery request Yes No

A/P Contact

A/P Email

A/P Phone

Estimated Monthly Deliveries $

Terms Requested: COD CREDIT CARD NET TERMS

– Credit Limit Requested $

Check one: Principal Partner Proprietor

Name

Home Address

City

State

Zip

Home Phone

Mobile #

Bank References

Name

Contact Name

Phone No

Street Address

City, State, Zip Code

Date Opened

Type of Account

Checking No

Saving No

Loan No

Trade References (Major Supplies)

1. Name

Contact Name

Phone No

Street Address

City, State, Zip Code

Account No.

2. Name

Contact Name

Phone No

Street Address

City, State, Zip Code

Account No.

3. Name

Contact Name

Phone No

Street Address

City, State, Zip Code

Account No.

I hereby certify that the information contained in this Application and any attachment is true, correct and complete. You consent to Vendor obtaining information about you personally, or to make inquiries into the banking and business/trade or other sources the Vendor deems appropriate in considering this Application. If credit is extended, you agree to be bound by all of the terms and conditions on Vendor’s invoices and posted on Vendor’s website.

Signature

Date

Title