LDP Logistics - Credit Application

LDP Logistics - Credit Application
Company Name*
Phone Number*

Country CodePhone Number
Address*

Street Address

Street Address 2

CityState / Province

Postal / Zip Code
Fax

Country CodePhone Number
DUNS
Enter in format: 123456789
TIN
Tax Identification Number
LDP Logistics Sales Representative*
Accounts Payable
Contact*
Email*
example@example.com
Phone Number*

Country CodePhone Number
Fax

Country CodePhone Number
Date Established*

MonthDayYear
Date
Trade References

Trade References should be U.S. suppliers of major products and/or services however please list references in accordance with the geographical location of the applicant.
1)
2)
Bank Reference

CheckingLoanSavings
Ownership*
1)
2)
Does your company participate in any global supply-chain cargo security program(s) i.e. Customs-Trade Partnership Against Terrorism (CTPAT), Authorized Economic Operator (AEO), Partners in Protection (PIP)?

YesNo
Identify security program name/certification number (if applicable)
Country of Certification

PERSONAL GUARANTEE
For good and valuable consideration and as an inducement to LDP LOGISTICS to issue credit to the entity herein named, the undersigned (jointly and individually) agrees to be personally liable for all indebtedness incurred by the above listed corporation or business entity. The undersigned (jointly and individually) further agrees to be personally liable for all indebtedness based on the extension of credit to any other corporation or business entity with which the undersigned is or may be affiliated.
Signature

Clear
Printed Name
Should be Empty:

Accounts Payable