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Name

Email

Legal Name*

D/B/A

Billing Address*

City, State, Zip*

Phone*

Fax

A/P Contact

Headquarters*
Please ChooseYesNo

If No, list headquarters address

Line of Credit Requested*

Electronic Payment Please ChooseYesNo

Type of Business*
Please ChooseCorporationPartnershipProprietorshipLLCLLP

Years in Business*

Federal Tax ID or SS Number*

Principal Full Name and Title*

Principal Full Address*

Principal Phone*

Bank Name*

Bank Phone*

Account Number*

Bank address*

Bank Officer Contact*

ALL INFORMATION RECEIVED WILL BE HANDLED CONFIDENTIALLY.

TERMS OF PAYMENT/STATEMENT

All Star Freight terms of payment are net 15 days from date of invoice. We reserve the right to add finance charges after 20 days of 5% per month or the highest rate permitted by law.

I (We) will be responsible for any shipments which I (we) choose to bill to a third party. I (We) agree to and understand the above stated terms of payment. I (We) authorize and release approval for All Star Freight, it's subsidiaries, and assignees to investigate all trade and bank references.

Agreed to (ENTER FULL NAME)*

Date (00/00/0000)*