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

CorporationLLCPartnershipSole Proprietor

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

FF# (Freight Forwarder) https://www.fmcsa.dot.gov/registration/op-1-ff-application-freight-forwarder-authorityMC/MX# (Common Carrier or Freight Broker)U.S. DOT#None of the above

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 Transportation 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

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.

6324 NW 79th Avenue

Doral, FL 33178

p: (305) 805-9090

PayCargo also accepted

I certify that by submitting this form below 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!