New Customer Profile and Credit Application

New Customer Profile and Credit Application
Please complete form in its entirety.
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 #*
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*

CorporationLLCPartnershipSole Proprietor
12. CEO or Owner's Name*

First NameLast Name
13. Operations Contact*
14. Operations Contact Email*
example@example.com
Group or alternate operations email
example@example.com
15. Operating authority type:*

FF#MC#U.S. DOT#None of the aboveOther
Please enter operating authority# checked above or enter "none". Authority #*
16. TSA/Security/Compliance Contact

First NameLast Name
17. TSA/Security/Compliance Contact Email
example@example.com
18. CFO or Accounts Payable Contact*

First NameLast Name
19. CFO or Accts Payable Contact Email*
example@example.com
20. Email Address for Receiving Invoices & Supporting Documents*
example@example.com
21. List Three Transportation Trade References, Address, Contact, and Phone#
22. Banking Information - Bank Name, Contact, Phone#
Upload credit, banking, and additional information helpful in establishing a business relationship & credit line.

File Upload
Multiple Uploads Accepted Cancelof
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

Remit checks to:

Cargo King Express Inc.

3171 SW 20th Court

Ft. Lauderdale, FL 33312

p: (305) 805-9090

PayCargo also accepted
I certify that by signing this form below 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 information provided in this application shall not be shared and is kept confidential.
25. Authorized Representative's Name*

First NameLast Name
Thank you for the opportunity to serve you!
Should be Empty: