Customer Application For Credit Account

CUSTOMER APPLICATION FOR CREDIT ACCOUNT

Return to: Fax: 1-306-665 3399 or dispatch@bazztransport.com

Legal Business Name:

9 –digit DUNS#:

Trade Name (Doing Business As):

Address:

City/ Province/State:

Postal/ZIP Code:

Country:

Tel No:

Fax No:

Website:

Head office(if different from above):

Address:

City/ Province/State:

Postal/ZIP Code:

Country:

Tel No:

Fax No:

Website:

Send Statement to Local, or Head office:

POD required?

List any special billing instructions:

Accounts Payable Contact:

Ext. #:

A/P email:

Business Principal(s):

Title:

Business Principal(s):

Title:

Year/Date Business Established:

Credit Amount requested:

Nature of Business:

ICC # or, MC#

GST #

Trade references:

	Name	Address	Phone#	Fax#	Email#
1
2
3
4

Bank References:

	Name	Address	Phone#	Fax#	Email#
1
2

I/WE UNDERSTAND THAT FREIGHT BILLS ARE SENT TO US ON A DAILY BASIS AND ARE PAYABLE WITHIN 30 DAYS FROM THE DATE OF BILLING. IN CONNECTION WITH MY APPLICATION FOR CREDIT, I HEREBY CONSENT TO & AUTHORIZE BAZZ TRANSPORT LTD. BROKERAGE DIVISIONTO CONDUCT INVESTIGATION, INCLUDING OBTAINING CREDIT INFORMATION.

BAZZ TRANSPORT IN. BROKERAGE DIVISION RESERVES THE RIGHT TO CHARGE INTEREST ON ACCOUNT BALANCES OVER 30 DAYS AT A RATE OF 1.5% PER MONTH, OR 18% PER ANNUM. IT IS UNDERSTOOD THAT CREDIT CAN BE WITHDRAWN WITHOUT PRIOR NOTICE.

Signed:

Title:

Date:

Print Name: