Please fill out the credit application below and a member of our team will be in contact. Any questions can be directed to fpuentes@hpltn.com.

Date: *

Date:

YYYY

Company: *

Billing Address: *

Physical Address: *

Phone: *

Phone:

(###)

###

####

Fax:

(###)

###

####

Contact: *

Contact:

First Name

Last Name

Years in Business:

Incorporated? *

President/Owner:

Federal I.D.# *

Bank/Branch: *

Bank Address: *

Account Number: *

Bank Contact Name: *

Trade References:

Trucking References:

Terms: *

By checking this box, we understand that terms on all invoices are net 30 days from date of invoice. We agree that upon approval of this application we will abide by the credit terms and limits established by High Point Logistics, LLC. In the event that our account is forwarded to an attorney or other agency for collection, with or without suit, we agree to pay collection costs, and reasonable attorney fees. We agree to pay a service charge of $50.00 for any returned checks.

I agree

Signature: *