New Customer Profile and Credit Application

Please complete form in its entirety. * are required fields.

1. Company Legal Name

2. Additional Company Names, Affiliates, Alias' or d/b/a

3. State or Province Incorporated

4. Your Location Description

5. Authorized Representative Requesting Account

First NameLast Name

6. Your title

7. Your Email

example@example.com

8. Your Phone #

Format: (000) 000-0000.

9. Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

10. Billing Address if Different from Above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

11. Organization Type

State of Incorporation

12. CEO or Owner's Name

First NameLast Name

13. Operations Contact

14. Operations Contact Email

15. Group or alternate operations email

example@example.com

16. Authority Type (Issued by FMCSA)

17. Authority #

18. TSA/Security/Compliance Contact (if applicable)

First NameLast Name

19. TSA/Security/Compliance Contact Email

example@example.com

20. CFO or Accounts Payable Contact

First NameLast Name

21. CFO or Accts Payable Contact Email

example@example.com

22. Email Address for Receiving Invoices & Supporting Documents

example@example.com

23. List Three Trucking Trade References, Address, Contact, and Phone#

24. Banking Information - Bank Name, Contact, Phone#

25. Upload credit, banking, and additional information helpful in establishing a business relationship & credit line.

File Upload

Multiple Uploads Accepted /Valid file types pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, jpg, jpeg, png, gif

Payment terms are net 30 days from invoice date.

Please remit payments via:

ACH:

Contact accounting@cargokingexpress to request Bank ACH routing and account information

If by check remit to address:

Cargo King Express Inc.

6324 NW 79th Avenue

Doral, FL 33178

p: (305) 805-9090

PayCargo also accepted

I certify that by submitting this form that the information and any documents uploaded herein are true and correct and that I agree and accept Cargo King Express' "Terms and Conditions" & payment terms. The authorizing individual's name by the act of submission of this form is authentic as a digital signature. The information provided in this application shall not be shared and is kept confidential.

26. Authorized Representative's Name

First NameLast Name

Title

Email

Thank you for the opportunity to serve you!