Jatac Logistics Credit Review Application

BUSINESS CONTACT INFORMATION

Major Shareholder Name:___________________________________________DUNS#:________________________________________________________

Company Name:__________________________________________________

Phone:_____________________ FAX:_________________________ Website:________________________________________________________

Registered Company Address:_______________________________________________________

City:_________________________ Prov/State__________________________ Postal/ZIP Code________________________

Date Business Commenced:_______________________ FEIN:___________________________________________________

Sole Proprietorship:__________________Paternership:___________________ Corporation:___________________ Other:_____________________

BUSINESS AND CREDIT INFORMATION

Primary Business Address:__________________________________________________________

City:_____________________________________________________ Prov/State:_____________________ Postal/ZIP Code:___________________

How Long at Current Address?_______________________________

Telephone:___________________________ FAX:______________________________ AP Contact:________________________________________

Terms Requested: 1% 10 NET 30 ___________Email Address:_______________________________________

BANK REFERENCE

Bank Name:________________________________________________________________

Bank Addresss:_________________________________________________ Phone:_____________________________________________

City:____________________________________ Prov/State:___________________________________

Type of Account:________________________________________ Account Number:______________________________________________

Checking:____________________________________________ Other:________________________________

BUSINESS/TRADE REFERENCES

Company Name:_____________________________________________________

Address____________________________________________________________

City:_________________________________________ Prov/State:__________________________ Postel/ ZIP Code:________________________

Phone:________________________________________ FAX:______________________________ Attn:__________________________________

Company Name:__________________________________________________________________

Address:________________________________________________________________________

City:__________________________________________ Prov/State:__________________________ Postel/ZIP Code:___________________________

Phone:_________________________________________ FAX:______________________________ Attn:____________________________________

Company Name:_______________________________________________________

Address:_____________________________________________________________

City:___________________________________________ Prov/State:__________________________ Postel/ZIP Code:___________________________

Phone:__________________________________________ FAX:______________________________ Attn:____________________________________

AGREEMENT

By submitting this application, we authorize you to make inquiries into the banking and business/trade references that we have supplied.

Please print document, fill out all information required and FAX to 281-459-2348

 

AUTHORIZING SIGNATURE AND DATE:__________________________________________________________________