Credit Application
The undersigned company is applying for credit with Courier  Systems and agrees to abide by the standard terms and  conditions of Courier Systems as reflected on the bottom of  this application.
*Denotes a required field.
*Company Name:
DBA (if different):
*Physical Address:
*City:
 *State: *Zip:
Billing Address is the same as Physical Address
*Billing Address:
*City:
 *State: *Zip:
*Primary Contact:
Alternate Contact:
*Phone:
*Fax:
Email Address:
* Corporation Partnership Sole Proprietorship
*Type of Business:
*Date Established:
 *# of Employees:
*Anticipated # of 
Deliveries per Month:
*Type of Items 
to be Shipped:
Referred By:
*Bank Name:
 *Account #:
*Contact:
 *Phone #:
Trade References
#1    Name:
 Contact:
Address:
 Phone #:
#2    Name:
 Contact:
Address:
 Phone #:
#3    Name:
 Contact:
Address:
 Phone #:
Additional  Information:
I represent that the above information is true and correct and it is provided to induce Courier Systems to extend credit to the applicant. My company and I authorize Courier Systems to make such credit inquiries as it may require in order to establish a credit account. By checking the box below, I authorize all trade references, banks and credit reporting agencies to disclose to Courier Systems any and all information concerning the financial and credit history of my company and/or myself.

General Terms and Conditions of Credit

  1. All bills are due and payable in full upon receipt.
  2. A service charge of 2% per month will be added to all amounts not paid within 30 days of billing receipt.
  3. In the event of non-payment Client is responsible for any and all applicable legal and/or collection fees incurred by Courier Systems.
  4. Courier Systems reserves the right to suspend the provision of services and/or require payment on delivery for past due accounts.
  5. PERSONAL GUARANTEE: By checking the box below the client personally guarantees payment of all services received from Courier Systems.

* I AGREE to the above Terms and Conditions of Credit, and I certify that all provided information in the above form is true and correct.