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800.578.6009

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Credit Application

Firm Name

Phone

Street Address

City State Zip

Billing Address

Billing Address

City State Zip

Use company for billing address

Shipping Address

Shipping Address

City State Zip

Use company for shipping address

AP Contact Phone AP Email

Invoices and Statements will be emailed to the above address. Paper copies are not available.

Type of Business How Long in Business Number of Employees

Bank Name

Phone

Street Address

Fax

City State Zip Contact

Trade References

Name

Phone

Street Address

City State Zip

Name

Phone

Street Address

City State Zip

Name

Phone

Street Address

City State Zip

Primary Account User

Individuals wishing to receive all freight, scheduling, confirmation, and billing emails (Parts Manager, Shipping Manager, etc.)

Authorized Signature Email

Authorized Signature Phone

I hereby authorize Freight Buddy to receive full information as requested, relating to our credit and bank experiences.