City Central Courier, Inc.

Credit Application

Please print this form and fax information to 713-623-0803.

 

Firms Name: ____________________________ Telephone:   (____)________________

 

Address: _______________________________ Fax number (____)________________

 

City: ____________ State: ___   Zip: _____-____ Website: _______________________

 

Billing address:  _________________________________________________________

 

Invoices Attn. To:  ________________________ Telephone: (____)________________

 

Co ntact name: ___________________________ Telephone: (____)________________

 

EIN or SS Number: ________________________ Years in Business:  _______________

 

Authorizing Manager’s Name: ______________________   Position:  _______________

 

Last Messenger Utilized: __________________________ How Long:  _______________

 

Average Number Deliveries per Week: ________ Domain address:  ________________

 

Would you like to use CityCentralCourier.com internet ordering system?  Yes / no

 

City Central Courier, Inc. bills its approved clients SEMI-MONTHLY, and out terms of payment are DUE UPON RECEIPT.  I also understand that by completing this document, my company is accepting the terms and conditions here stated. I am authorized in my capacity, to bind my firm for any and all credit extended to us. Failure to meet these terms may cause interruption of services and also may cause City Central to employ an attorney for the process of collection. I further understand that each shipment will automatically carry a maximum declared value of $50.00 unless a greater value is specified at the time the service is ordered.

 

 

Signature ___________________________

 

         Title ___________________________

 

        Date ___________________________

 

On acceptance of this document, City Central Courier, Inc. will create pre-printed delivery tickets that we will forward to you. Thank you for your business.

 

Please print this form and fax information to 713-623-0803.