Credit Account Application Form

Credit Account Application Form
Company Name:
Trading As:
Email
example@example.com
Phone Number
Please enter a valid phone number.
Registered Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Invoicing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Reg #
VAT Number #
Anticipated monthly credit required/Monthly bookings:
Nature of the business:
Invoicing contact name, email and number
Despatch contact name, email and number
I declare that the above details are true and correct to the best of my knowledge. I authorise you to approach my reference if required. I undertake to pay in full any monies due in accordance with your stated credit terms. I further agree to abide by your terms and conditions of carriage, copies of which are available on City Quick Logistics Ltd website and also in my possession. I understand this is the essence of the contract between us.
Name

First NameLast Name
Date

MonthDayYear
Date
Please type name as form of signature
Please verify that you are human*
Should be Empty: