Credit Application:
Please provide us with the following information and we'll get back to you as soon as possible with the credit terms we can provide you. Don't worry if you can't complete all of the form. We can call you if we need clarification.

YOUR COMPANY INFORMATION
Company:		Division of:
Address:
City:	State:    Zip Code:
Phone:		Fax:
Federal Tax ID:		Are you incorporated?
Date Company Established:		Annual Sales:
YOUR TRADE REFERENCES (please include trucking companies you have used):
Company:
Phone:		Contact Name:
Customer Since:		High Credit:
Last Sale:		Balance Outstanding:
Company:
Phone:		Contact Name:
Customer Since:		High Credit:
Last Sale:		Balance Outstanding:
Company:
Phone:		Contact Name:
Customer Since:		High Credit:
Last Sale:		Balance Outstanding:
Company:
Phone:		Contact Name:
Customer Since:		High Credit:
Last Sale:		Balance Outstanding:

Please email back to us at Info@shipeasy.com.  
Or, you can fax it to us at 1-909-466-7393.    

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