CitiCouriers credit application

Company Information
*Company Name *Company Phone
*Contact Person Contact Person Phone
Street Address City State Zip
Mailing Address (if different from above) *Email Address
Ownership Information
Type of company: Corporation Partnership Sole Proprietor
Tax ID #  
Name of Owner Title
Name of Owner Title
Credit Reference Information
Business Name Address Phone
Business Name Address Phone
Billing Information
Invoice: Sort by date Sub total by Reference Page Break by Reference
Reference Style: Client Matter Client Name Callers Name
Estimated Monthly Volume: Under$100 Over$100 Over$500
Terms: Billing occurs Semi-Monthly or Monthly (depending on your volume). Our payment terms are net upon receipt of invoice. Past Due balances (over 30 days) are subject to a finance charge of 1.5% per month and a late fee of $15.00.
Authorizing Person Title Date