Q Ship USA Corp. Credit Application

IMPORTANT: Please complete the Q ShipUSA
Credit Approval Form below, sign and submit.
A representative from Q ShipUSA will be in touch with you to confirm the application was received successfully.
COMPANY NAME *
STREET ADDRESS *
CITY *
PROV/STATE *
POSTAL ZIP *
PHONE
FAX
OTHER
E-MAIL
example@example.com
DATE OF INCORPORATION/PARTNERSHIP

Month Day Year
Date
1.NAMES OF PRINCIPALS OFFICERS:
TITLE
2. NAMES OF PRINCIPALS OFFICERS:
TITLE
ESTIMATED MONTHLY REQUIREMENT
SPECIAL BILLING INSTRUCTIONS
BANK NAME:
ADDRESS
ACCT
BRANCH
PHONE
CONTACT
1. CREDIT REFERENCE
NAME
PHONE
ADDRESS
FAX
2. CREDIT REFERENCE
NAME
PHONE
ADDRESS
FAX
3. CREDIT REFERENCE
NAME
PHONE
ADDRESS
FAX
COMPANY ACCOUNTING CONTACT
Name
Phone #
Email
Q Ship USA Corp.
*Customer agrees to pay for all Services as actually provided, including any accessorial charges and adjustments to the original rate issued by the carrier. Liability for freight loss and damage resides exclusively with the motor carrier transporting the freight. Customer agrees that payment of freight charges may not be postponed or setoff due to alleged loss, damage or delay to freight. Customer agrees to pay these freight charges in full, and if necessary submit to broker a written claim. Broker agrees to submit, negotiate and settle all claims with the responsible carrier and to keep Customer advised of the status of all such claims.

My signature below indicates my agreement to the above and my permission to obtain credit information from the sources referenced and attests financial responsibility to pay invoices in accordance with terms.
CREDIT LIMITS ARE 15 DAYS
SIGNATURE

Clear
DATE

Month Day Year
Date
POSITION
Should be Empty:

1. CREDIT REFERENCE

2. CREDIT REFERENCE

3. CREDIT REFERENCE

COMPANY ACCOUNTING CONTACT

Q Ship USA Corp.

CREDIT LIMITS ARE 15 DAYS